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Doctor K: Treatment for JRA not without risks

DEAR DOCTOR K: My young granddaughter has juvenile rheumatoid arthritis. I worry about the effects of the powerful medications she has to take.

DEAR READER: Modern medicine has created real miracles. We have been smart enough to create treatments that relieve suffering and prevent premature death beyond what was previously possible. But we are not yet smart enough to create tests and treatments that are free of side effects.

The treatment of arthritis, in adults and in children like your granddaughter, is an example. Powerfully effective treatments are available today that were not available in the past. Your granddaughter’s suffering has a better chance of being relieved than ever before.

With juvenile rheumatoid arthritis, the lining of the joint becomes inflamed and enlarged, limiting movement and causing pain and tenderness. Enzymes released by the inflamed membranes erode the bone and cartilage. This joint and bone damage can cause problems in a growing child; bones may develop abnormally in shape or size.

Medications help to control inflammation to stop further joint damage. They also control pain and inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first medications used to relieve joint inflammation. But NSAIDs can cause ulcers. COX-2 inhibitors may be safer for the stomach.

In more severe cases, doctors may use corticosteroids, which are fast-acting, anti-inflammatory agents. But they can cause weakened bones, increased susceptibility to infections and stunted growth. They usually are prescribed for only a short time.

Drugs known as DMARDs often provide relief if other medications have failed. The most widely used is methotrexate. These drugs can cause liver damage or other complications. Doctors carefully monitor children taking DMARDs.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to