Juvenile Idiopathic Arthritis (JIA)

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Treatment Options

Each person's immune system is unique and treatment for Juvenile Idiopathic Arthritis varies from person to person. Treatment usually includes medications to alleviate symptoms and decrease the inflammation present in the joints and other areas of the body to suppress or slow down the immune system and thus slow down progression of the disease.

Although non-steroidal anti-inflammatory medications, such as aspirin and ibuprofen are used to reduce symptoms; the mainstay of treatment is most often Methotrexate and joint injections with steroid. New medications called biologic treatments that target specific inflammatory proteins called cytokines are very effective for some patients. Additional medications may include: sulfasalazine, plaquenil, Cyclophosphamide (Cytoxan) or Azathioprine (Imuran). Some patients may even be treated with a bone-marrow transplant (also called autologous hematopoietic stem cell transplant).

Innovative new treatments for autoimmune diseases

A Hutchinson Center team is examining the feasibility of using bone-marrow transplantation as a treatment for autoimmune diseases. These diseases are a group of about 50 ailments whose symptoms range from mild rashes to life-threatening conditions that attack major organ systems. Though each disease is different, all begin with an immune-system malfunction: destruction of the body's own normal tissue by cells that typically fight infections caused by bacteria, viruses, and other micro-organisms.

The rationale for the approach is that the high-dose radiation and chemotherapy used to wipe out cancers of blood and bone marrow may be used to suppress the immune system. This high-dose therapy eliminates not only the immune system's ability to fight infection, but also its ability to attack the patient's tissues. The new immune system that regrows from selected stem cells taken from the patient's own blood will be composed of immature cells that will not include the reactive cells that trigger the immune system to attack the body. Because many autoimmune diseases begin during middle age, it is thought this stem-cell transplantation will "turn back the clock" on immune system development in these patients.

The early phase studies showed that transplantation provides promising improvement in patients' conditions, and that larger randomized comparison studies are needed to determine the long-term benefit to patients.

The team is leading a multi-center trial using autologous stem-cell transplantation for scleroderma, lupus, multiple sclerosis, and juvenile idiopathicarthritis.

Dr. Ann Woolfrey is conducting a study looking at high-dose immunoablative therapy followed by autologous hematopoietic stem cell transplant for the treatment of refractory autoimmune disorders, including juvenile idiopathicarthritis.

The primary goal is to determine whether destroying the immune system followed by rescue with purified autologous stem cells could result in restoring the immune system without the recurrence of the disease. Patients eligible include children with juvenile idiopathic arthritis, systemic lupus erythematosus, systemic sclerosis, or dermatomyositis.