Pediatric emergency medicine trisk 2987 2987
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TABLE 101.12
NSAIDs USED IN THE TREATMENT OF ARTHRITIS IN CHILDREN
Drug
Doses/day Dose (mg/kg/day)
Side effects
Ibuprofen (Motrin,
Advil, Pediaprofen)
Naproxen (Naprosyn,
Aleve)
3–4
30–40 (maximum
2,400 mg/day)
10–20 (maximum
1,000 mg/day)
Gastric irritation,
chemical hepatitis
Gastric irritation,
behavioral changes,
headache,
photosensitivity
Meloxicam (Mobic)
1
0.25 (maximum 15
mg/day)
Gastric irritation,
headache, fever
Indomethacin (Indocin) 3
1.5–3 (maximum 200
mg/day)
Gastric irritation,
headache, chemical
hepatitis
Celecoxib (Celebrex)
10–25 kg: 50 mg/dose
(maximum 100
mg/day)
Gastric irritation,
cough, rash
(including Stevens–
Johnson syndrome)
2
2
>25 kg: 100 mg/dose
(maximum 200
mg/day)
>40 kg: 200 mg/dose
(maximum 400
mg/day)
NSAIDs, nonsteroidal anti-inflammatory drugs.
Medications. The pharmacologic management of JIA has changed dramatically over
the recent past because of the understanding that most children continue to have active
synovial inflammation for decades and do not “outgrow” their disease. Accordingly,
modern therapy aims not only for relief of the symptoms of pain and stiffness, but also
for joint protection through suppression of synovial inflammation. Consequently,
physicians caring for these children must be familiar with the intended and unintended
effects of a wide variety of anti-inflammatory and immunomodulatory medications.
NSAIDs are the initial agents used in most children with JIA. In addition to the
better known NSAIDs, COX-2 inhibitors may be used to treat JIA ( Table 101.12 ).
These agents, such as celecoxib, are anti-inflammatory drugs specific for the inducible
isotype of the cyclooxygenase enzyme, resulting in fewer GI side effects than
traditional mixed COX-1 and COX-2 inhibitors. For children who respond
