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Biologics for Juvenile Idiopathic Arthritis

Examples

Generic Name Brand Name
abatacept Orencia
adalimumab Humira
etanercept Enbrel
infliximab Remicade
tocilizumab Actemra

How It Works

Biologics block harmful responses from the body's immune system that lead to the symptoms of juvenile idiopathic arthritis (JIA).

Why It Is Used

Biologics are used to treat moderate to severe JIA symptoms and to prevent joint damage, particularly in people who have had side effects or poor results from methotrexate treatment.

Biologics are usually used after nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and methotrexate have been tried. A biologic is often used at the same time as these other medicines, especially to treat polyarticular JIA and extended oligoarticular JIA.1

Biologics may also be tried when eye inflammation has not improved after trying other drugs such as corticosteroids and mydriatics.

How Well It Works

Etanercept is most widely studied for juvenile idiopathic arthritis. In general, biologics improve symptoms, help prevent bone and cartilage damage, and may even help with healing.2

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine your child takes. Side effects are also listed in the information that comes with the medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after your child takes the medicine for a while.
  • If side effects still bother your child and you wonder if he or she should keep taking the medicine, call your doctor. He or she may be able to lower the dose or change the medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if your child has:

  • Trouble breathing.
  • Hives.
  • Swelling of his or her face, lips, tongue, or throat.

Call your doctor right away if your child has:

  • Signs of illness or infection, such as chills, cough, or fever.
  • A rash on his or her head, face, or belly.

Common side effects of this medicine include:

  • Nausea and vomiting.
  • Stomach pain.
  • Painful throat.
  • Redness, itching, or swelling at the injection site.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Warnings about serious side effects of biologics have been issued. The U.S. Food and Drug Administration (FDA) and the drug’s manufacturers have warned about:

  • An increased risk of a serious infection. Biologics affect the body's ability to fight all infections. So if your child gets a fever, cold, or the flu while he or she is taking this medicine, let the doctor know right away.
  • An increased risk of blood or nervous system disorders. Call the doctor if your child has symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
  • A possible increased risk of developing lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk. There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking a type of biologic called a TNF antagonist, that often results in death.
  • An increased risk of liver injuries. Call the doctor if your child's skin starts to look yellow, if he or she is very tired, or if your child has a fever and dark brown urine.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. If your child takes medicine as your doctor suggests, it will improve your child's health and may prevent future problems. If your child doesn't take the medicines properly, his or her health (and perhaps life) may be at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Weiss JR, Ilowite NT (2005). Juvenile idiopathic arthritis. Pediatric Clinics of North America, 52(2): 413–442.
  2. Soep JB, Hollister JR (2009). Juvenile idiopathic arthritis section of Rheumatic diseases. In WW Hay Jr et al., eds., Current Diagnosis and Treatment Pediatrics, 19th ed., chap. 27, pp. 796–799. New York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Specialist Medical Reviewer Stanford M. Shoor, MD - Rheumatology
Last Revised July 29, 2011

Last Revised: July 29, 2011

Author: Healthwise Staff

Medical Review: John Pope, MD - Pediatrics & Stanford M. Shoor, MD - Rheumatology

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