Juvenile Spondyloarthritis (JSpA)
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MEDICATION
Overview
There are a number of different types of medications that have been found to be effective in managing the symptoms of ankylosing spondylitis and related diseases. In terms of medication, Juvenile Spondyloarthritis (JSpA) is treated in much the same way as spondylitis is in adults.
NOTE: Different people respond to different medications with varying levels of effectiveness. Thus, certain medications may work as well, depending on the individual. It may take time to find the most effective medication.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are the most commonly used class of medication used in treating the pain and stiffness associated with JSpA. For example, Ibuprofen is a generic NSAID and is found in over-the-counter pain relievers such as Advil and Motrin. They commonly come in tablet form and are taken orally.
Sometimes high doses of NSAIDs are needed to maintain relief from the symptoms of JSpA. This can pose a problem in that NSAIDs can cause significant side effects, especially in the gastrointestinal tract (stomach, intestines, etc.) NSAIDs can cause reduction in the protective mucus in the stomach, which can cause stomach irritation. In time, this can lead to heartburn, gastritis as well as ulcers and even bleeding. People can take other medications to neutralize or prevent the production of excess stomach acid to help prevent these side effects (such as antacids), take drugs to help coat and protect the stomach (such as Carafate), or take medication to help restore the lost mucus (such as Cytotec).
A newer class of NSAIDs known as COX-2 inhibitors (or COXIBs) allegedly reduce the risk of gastrointestinal complications associated with traditional NSAID therapy. However, in recent months two of the COX-2 inhibitors have been found to have their own potential, serious side effects. One of the more regularly prescribed COX-2s, Vioxx (Rofeocoxib), was pulled from the worldwide market because of the possible increased risk of heart attack when taking the medication. Another COX-2, Bextra, was also pulled from the market in April of 2005.
***Position Statement from SAA's Medical and Scientific
Advisory Board on the COX-2 Inhibitors***
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Celebrex, Arcoxia, and Vioxx are examples of a class of drug known as
the COXIBS. It appears that all anti-inflammatory agents, COXIB and
non-COXIB, may have the potential to increase the risk of heart attacks,
heart failure, and strokes. Patients with past and/or current heart
disease, and those at serious risk of heart disease (e.g. diabetics),
should check with their physician before continuing to take any of these
medications
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Other less common side effects from NSAIDs include headaches, dizziness, fluid retention and even confusion.
Below are the names of the more commonly used NSAIDs in treating JSpA as well as links to more information on each drug.
When NSAIDs Are Not Enough?
Although NSAIDs are commonly the first line of medications used to treat JSpA, sometimes they aren't enough to control the symptoms. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. If you are considering changing medications, remember to ask your doctor about the potential benefits and side effects before you and your doctor decided whether the change in treatment is right for you.
Listed below are other medications that are sometimes used to treat JSpA.
Stay Informed!
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Stay up-to-date on all the latest news and information regarding AS and related diseases including medications with our news magazine, Spondylitis Plus. Your subscription comes free with SAA membership.
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Sulfasalazine
Sulfasalazine is one type of medication that can be helpful to some people with severe disease, including children. It is known to effectively control not only pain and joint swelling from arthritis of the small joints, but also the intestinal lesions in inflammatory bowel disease. It comes in tablet form and is taken orally.
Side effects are relatively infrequent, but can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, which is why it is important for your doctor to regularly monitor your blood count.
AZULFIDINE (Sulfasalazine)
Patient Information
Methotrexate
Originally developed to treat cancer, this chemotherapy drug is widely used and often very effective for the treatment of rheumatoid arthritis. When prescribed for treating ankylosing spondylitis or related disease, it is given in much smaller doses. Methotrexate can either be taken via a self-injectable shot, or orally in tablet form. When taking methotrexate, it is also necessary to take the vitamin folic acid in order to help suppress possible side effects.
Oral ulcers and nausea are the most common side effects, but can be minimized by taking folic acid. Because of other potential serious side effects, the frequent monitoring of blood counts and liver tests are required.
Corticosteroids
Corticosteroids such as prednisone can be effective in relieving the inflammation of JSpA, but the side effects of long-term use can be very severe. Corticosteroid injections into the inflamed joints can provide temporary relief of the pain caused by arthritis or bursitis. In instances of Achilles' tendonitis, such injections are rarely, if ever used because of the risk of rupturing the Achilles tendon. Also, the usefulness of corticosteroid injections to relieve the symptoms of plantar fasciitis (heal pain) is not clear. More information on corticosteroids can be found at Medline Plus.
The Biologics: TNF Inhibitors
The Tumor-Necrosis-Factor alpha (TNF-a) blockers are biologic medications that have shown great promise in treating ankylosing spondylitis and related diseases. However, to date there are no studies of these treatments in children with JSpA, and therefore no recommendations to date. Although studies in children will need to be done, TNF blockers are already used for other types of childhood arthritis and therefore are likely to be relatively safe and effective in JSpA.
In July of 2003, the first biologic medication was approved by the FDA for the use in treating ankylosing spondylitis: Enbrel (etanercept). It is a self-injectable medication administered either once or twice a week.
The second medication in this class to be approved by the FDA for treatinng ankylosing spondylitis is named Remicade (infliximab). It was approved in December of 2004. Remicade is administered as an intravenous infusion in the doctor's office every six-to-eight weeks.
The other TNF-a blocker that has gained FDA approval for the treatment of AS, specifically, is Humira (adalimumab). It was approved in July of 2006. Humira is also an injectable medication, though only every other week, and normally self-injected.
The most serious known side effect of the TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is ususally required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).
Click here for more information in our Ongoing Special Report: The Biologics, TNF Inhibitors.
Note that not everyone with ankylosing spondylitis or related disease will need these medications. You and your doctor can decide which of these medications, if any, would be best for you.
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