Enthesitis related arthritis is that form of arthritis, where inflammation and swelling occurs at point of attachment of ligaments or tendons to the bone. When it occurs in children it is referred as juvenile Enthesitis related arthritis (ERA). ERA results in stiffed, swollen and painful joints of feet, knees, hips, ankles and lower back. In children suffering from ERA, the immune system responds by producing and sending cytokines all throughout the body. These cytokines bind to entheses and joints, causing inflammation.
The symptoms of ERA include pain with swelling, observed more commonly at fingers, toes and heels that look more like sausages due to inflammation at entheses. Some children may also experience pain or/and swelling at pelvis, chest and elbow. Medicines used to cure ERA are prescribed based on the body size, aiming at using the minimum dose of medicine as far as possible, to overcome symptoms and inflammation of ERA.
Helpful Ways To Cure Enthesitis Related Arthritis
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs drugs like meloxacin, naproxen, indomethacin and ibuprofen help to improve joint movement. These drugs are available as capsules or pills and improve ERA symptoms within 2 to 3 months that need to be consumed for 1- 3 times in a day, depending upon the extent of the disease. While on one NSAIDs, the other NSAID drug should never be consumed. Side effects of these medications can upset stomach or cause stomach pain.
Immune System Suppressing Drugs
In certain cases, NSAIDs might not be fruitful as the condition may demand much stronger drugs that inhibit the functioning of immune system and aids in controlling inflammation and joint damage.
These drugs reduce the number of immune cells that attack entheses and joints. Medicines include prednisone, sulfasalazine, methotrexate and biologics.
ERA patients may require prednisone for a short duration to control inflammation of entheses and give certain time for medications to start working. But, the dosage and duration for the medicine should be properly followed as stopping abruptly make worse the situation.
Sulfasalazine And Methotrexate
These two drugs are second line medicines that need to be taken, when NSAIDs alone are not effective. To observe complete benefits of these medicines, a minimum of 3 months treatment will be required.
Sulfasalazine is taken along with a meal or snack to prevent stomach upset, whereas methotrexate should be consumed on an empty stomach. Along with methotrexate, folic acid vitamin must be taken to lower the side effects of mouth ulcers and nausea.
One need to undergo blood tests to ensure these drugs does not stop production of red blood cells, white blood cells and platelets. Moreover, it gives a check whether methotrexate is harming the liver, by performing liver function tests.
These drugs are required when NSAIDS and other medicines are unable to manage entheses inflammation. Biologics are able to block cytokines formed by immune system and provide great relief from inflammation. Biologics include adalimumab, infliximab and etanercept and are given as subcutaneous injection or intravenous infusion into veins.
Biologics do not show side effects, but one may become prone to infections. Therefore, the person needs to be analyzed for certain infections like tuberculosis, before consumption of biologics
Doctor may suggest for joint injections that may quickly reduce the inflammation. With these, improvement may be observed within 24 to 48 hours post injections, relieving patients from swelling and pain. Such joint injections are only performed when there is one or very less joints problem.