Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for JIA

What are non-steroidal anti-inflammatory drugs?

Most children and teenagers with JIA are treated first with non-steroidal anti-inflammatory drugs (NSAIDs). These are called first-line medications because they are usually the first type of medication a doctor will use to treat JIA. These medications do not contain steroids.

How do NSAIDs work?

How do Anti-inflammatory Medicines Work?
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As you have already learned, JIA is joint inflammation. NSAIDs decrease inflammation and help to reduce pain, swelling, and stiffness in the joints. These drugs can help a child with JIA to participate in normal day-to-day activities. It might take up to eight to 12 weeks to see improvement.

To learn more about how NSAIDs work, check out the animation at the right.

Types of NSAIDs

There are several different NSAIDs used to treat JIA. The choice of medication is based on the type of JIA the child has, how easy it is to take, and which drug the doctor thinks is best for him. Sometimes one NSAID might work while another might not. A child may need to try several NSAIDs to find which one works best for him. 

One good thing about NSAIDs is that their effect on JIA pain, stiffness, and swelling will not wear out over time (or make them less effective).  

Here are some commonly prescribed NSAIDs used to treat JIA.

NSAID generic name

Most common brand name

How it is given

How the medication comes

 Naproxen Naprosyn By mouth, twice daily Liquid or pill
 Ibuprofen

Advil; Motrin

By mouth, three to four times daily Liquid or pill
 Indomethacin Indocid By mouth, three times daily Liquid or pill
 Diclofenac sodium Voltaren By mouth, once or twice daily Pill
 Piroxicam Feldene By mouth, once daily Pill
 Celecoxib Celebrex By mouth, twice daily Pill

Side effects of NSAIDs

All of the NSAIDs listed in the table have the following side effects.

Common side effects:

  • stomach upset: pain, nausea

Less common side effects:

  • vomiting, diarrhea, or constipation
  • bloody or tarry black stools
  • severe abdominal pain from stomach ulcers
  • dizziness, drowsiness, headaches
  • rash, hives, or itching
  • fragility and scarring of the skin
  • nosebleeds, bleeding gums, easy bruising
  • anemia, mild abnormalities in liver or kidney function

Important safety points about taking NSAIDs

  • NSAIDs should always be taken with food. This can make it easier on the stomach.
  • One rare side effect of NSAIDs is stomach ulcers. If persistent stomach upset occurs with NSAID medication, ta​lk to the doctor. The doctor may prescribe a drug to help protect against the development of stomach ulcers. Signs of an ulcer may include vomiting blood or passing a bloody or black stool. If this occurs, you should stop the NSAIDs and see the doctor immediately.
  • The doctor may order blood and urine tests during a clinic visit to make sure that the medication is not causing any problems in the body that the child might not feel.
  • If an additional medication is needed for pain or fever, give acetaminophen (Tylenol). DO NOT GIVE another NSAID (like ibuprofen​: Motrin or Advil) because this would result in taking too much anti-inflammatory medication.  

Tips for managing side effects of NSAIDs

  • Make sure NSAIDs are taken with food. For example, try to pair taking the pills with breakfast, lunch, or dinner. If medications need to be taken at school, take them with a snack or lunch.
  • Some NSAIDs may make a child sun sensitive. Make sure to use adequate sun protection, like sunscreen, while taking NSAIDs, especially if fair-skinned.

Adam M. Huber, MSc, MD, FRCPC

Michael A. Rapoff, PhD

Lynn Spiegel, MD, FRCPC

Jennifer Stinson, RN, PhD, CPNP

Gillian Taylor, MSc(A)

Shirley Tse, MD, FRCPC

Lori B. Tucker, MD

12/27/2009


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