Juvenile Arthritis

June 21, 2017

Most people think arthritis only affects older people, but that is far from the truth.

Juvenile Arthritis has become a chronic childhood illness. About 300,000 children in the United States are diagnosed with arthritis. Typical symptoms include inflammation (swelling), joint pain, stiffness and tenderness. Morning time limping is also an early sign of juvenile arthritis.

Rheumatologist and FDA clinical team leader Nikolay Nikolov offers hope for those who have juvenile arthritis. Over the past few years, drug companies have been developing new treatments that can control the disease and its effects, which may reduce the onset of physical disability in later adult years.

The cause of juvenile arthritis is unknown, but what scientists do know is it is an autoimmune disorder in which the immune system attacks its own body tissue.

Juvenile Idiopathic Arthritis (JIA) is the name known for the collective group of conditions classified as juvenile arthritis that start before age 1 and has symptoms lasting for at least 6 weeks.

The wrists, ankles, knees and even smaller joints are impacted by JIA. Polyarticular JIA is the largest JIA subgroup because it impacts several joints. Systemic JIA is another subgroup that impacts the entire body and can cause skin rashes and fever.

Past treatment for juvenile arthritis included NSAIDS (non-steroidal anti-inflammatory drugs) like aspirin and ibuprofen. Corticosteroids and methotrexate are used in more severe cases to suppress immune response to the joints.

FDA-approved biologics (medicines originating from biological sources) are now being used to treat both systemic and polyarticular JIA.

Current JIA Treatments

Because of advanced science, doctors are now able to determine what encourages the occurrence of arthritis. Cytokines (molecules responsible for inflammation control in the body) like interleukins (IL), tumor necrosis factor (TNF) and other natural proteins that facilitate immune responses are the focus of new medicines.

Biologics are administered intravenously or subcutaneously (under the skin) over the course of several years to maintain symptom relief.  Not all biologics work the same on all subgroups of JIA.

Currently, there is no data on the long-term effects of these newer medications on children, but there is a lot of information on how these drugs affect adults with rheumatoid arthritis (RA). One also should be mindful that biologics suppressing the immune system can increase the risk of infections like tuberculosis in children.


Juvenile Arthritis

February 14, 2016

Arthritis is often referred to an old age disease, but this isn’t necessarily the case.

One of the most common chronic diseases that impact children is juvenile arthritis. It’s estimated that there are around 300,000 young people that are diagnosed with the disease. Common symptoms of the disease are tenderness, inflammation, joint pain, as well as joint stiffness. Limping in the morning may be an early sign of the condition.

At the FDA, Nikolay Nikolov is a clinical team leader and a rheumatologist he indicates that parents and children with juvenile arthritis have good reason to have optimism. In recent years there has been new therapies developed by drug companies and approval given by the FDA the help to control and moderate the condition. This helps prevent significant problems and disability in later years.

No one knows the exact causes of juvenile arthritis as it’s an autoimmune disorder. The immune system usually helps the body fight infection, but in the case of arthritis, it attacks the tissues.

Juvenile arthritis has several subgroups which are called Juvenile Idiopathic Arthritis (JIA). These start before the age of 16 and can cause swelling in one or more joints which lasts around six weeks. JIA impacts the knees, ankles, wrists, and other joints of the body. The largest group is called Polyarticular JIA and it impacts many joints. Systemic JIA is another subgroup and it impacts the entire body and cases skin rashes and fever in many cases.

In the past, children were treated with non-steroidal anti-inflammatory drugs (NSAIDs) for inflammation and pain relief using products like aspirin or ibuprofen. Children that have severe juvenile arthritis are treated with drugs which suppress the immune system of the body. Common products used for this are methotrexate and corticosteroids.

Now systemic JIA and Polyarticular JIA are treated with new medications which are called biologics. These are extracted or manufactured from biological sources.

The New Treatments for Juvenile Arthritis

Nikolov says that as our science has advanced at the molecular level, we ae learning more about what drives arthritis and we are able to identify important targets.

Targets include molecules that control and drive inflammation in the body which are called cytokines. These include interleukins (IL), tumor necrosis factor (TNF), and other proteins which occur naturally and work to stimulate the immune response in the body. The biologics used in treating juvenile arthritis are given subcutaneously (under the skin) or intravenously over a period of years. Different biologics work better for the subgroups of juvenile arthritis.

There’s no long-term safety information for the use of these drugs in children, but we have significant experience using them in adults that have RA. The Biologics are used to treat juvenile arthritis are potent drugs which suppress the immune system and can raise risks of opportunistic (unusual) infections, regular infections, and tuberculosis.

When a drug is found to benefit adults with RA in large clinical trials it may be studied by drug manufacturers to see if children with juvenile arthritis may benefit from the drug. The FDA considers the potential and known risks of a drug to determine is the benefits of using that drug outweigh the risks for children with juvenile arthritis.