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NSAIDs for juvenile idiopathic arthritis (JIA)

What are NSAIDs?

NSAIDs are non-steroidal anti-inflammatory medicines. They help reduce inflammation, pain, stiffness and fever.

NSAIDs are not a cure. They are commonly used to treat the symptoms of childhood inflammatory arthritis.

Higher doses may be needed to help reduce inflammation than are given just for pain relief.

It can take 4 to 8 weeks of taking the medicine regularly every day before the full effect of the medicine will be seen.

How do they work?

NSAIDs block an enzyme called cyclo-oxygenase. This prevents the production of molecules that are responsible for the inflammatory reaction. NSAIDs are a good first line treatment in JIA because they are usually beneficial and have few side effects.

What are the common NSAIDs used in JIA?

There is a wide range of NSAIDs that are used to treat JIA. Some NSAIDs can be bought over the counter (such as ibuprofen) for pain and fever relief but higher doses are often needed to treat JIA. These medicines need to be taken regularly every day to get the best effect. It is important to take the medicines in the way that your doctor has recommended for your child.

Generic name How is it given Dose Available as
Ibuprofen By mouth 3 to 4 times daily (sometimes up to 6 times per day) Liquid, tablet or meltlet
Naproxen By mouth 2 times per day Liquid or tablet
Indometacin By mouth 2 times per day Liquid or capsule
Diclofenac sodium By mouth 2 to 3 times per day Liquid, tablet or soluble tablet
Piroxicam By mouth 1 time per day Capsule or meltlet

Which NSAID is suitable for my child?

Different medicines will be chosen depending on what you have tried already, and the sort of medicine you child prefer (such as tablets or liquids) and how often it will be possible to take the medicine.

How effective are they?

NSAIDs are not a cure. They treat the pain and inflammation of arthritis.

Different NSAIDs may suit different children and if one does not work, a different one may still be effective.

There are other treatments that your doctor may decide your child needs either instead of, or as well as NSAIDs.

Are NSAIDs safe?

All medicines can have side effects but NSAIDs are considered to be very safe for children. Many children take NSAIDs without any problem but sometimes children may experience some side effects.

The most common side effects are gastrointestinal discomfort and feeling sick and some children may get diarrhoea.

Sometimes children can have bleeding and ulcers in the lining of their tummy or gut. Taking NSAIDs after food or a milky drink helps to prevent this.

Your doctor may prescribe a medicine to protect your child’s stomach. This must be taken every day if it has been prescribed.

Wheezing is rare but if your child has asthma they may become wheezier. If this happens let your child’s doctor know as a different medicine may suit them better.

Sometimes NSAIDs cause kidney problems. If your child has been unwell your child’s doctor may take a blood sample to check your child’s kidneys.

Other side effects can sometimes occur. A full list is in the manufacturer’s leaflet that you will receive with your medicines. If you think your child may be experiencing a side effect to their medicine check with your doctor before giving your child any more medicine.

Important safety points

  • Give your child NSAIDs after food as it will be easier on their stomach.
  • Consult your doctor within 24 hours if your child suffers from persistent stomach pain. If your child has blood in their sick, or passes a bloody or black poo then you should stop the NSAID and seek medical advice urgently.
  • Consult your doctor if any new symptoms develop.
  • If your child has a history of indigestion or stomach ulcers, then it needs to be discussed with your doctor before starting the medication.
  • If an additional medication is needed to treat your child for pain or fever whilst they are on an NSAID, then give them paracetamol rather than adding another NSAID. Check with your pharmacist before buying anything over the counter as many cold and flu remedies contain NSAIDs.
  • Check with your doctor or pharmacist before you give your child any other medicines. This includes herbal or complementary medicines.
  • Try to give your child medicines at the same time each day, to help you remember.
  • Make sure you always have enough medicine for your child. Order a new prescription in plenty of time so that you will not run out.
  • Keep all medicines in the container they came in and keep them in a place out of the sight and reach of children.
  • Never keep out of date or unwanted medicines. Give them to your local pharmacist who will dispose of them safely for you.

Do the NSAIDs have any effects on other medicines?

You should tell your doctor about all the medications that your child is taking, as NSAIDs may affect some other medicines.

If your child is taking methotrexate, this combination will need to be monitored carefully by your doctor.

Is it safe to take NSAIDs during pregnancy?

If NSAIDs should only be taken during pregnancy if absolutely necessary, and only in consultation with your doctor. They should be avoided during the last 3 months of pregnancy. NSAIDs may inhibit labour if used close to delivery.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: PHA10

Resource Type: Article

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