In recent years, several related classes of drugs, called biologics, have dramatically improved patient outlook for Juvenile Arthritis (JIA).
JIA causes pain and swelling in one or many joints. In some cases, the eyes and internal organs can also swell; rashes and fevers are also common. Over time, joints become deformed and degraded. But with newer medications, these hallmarks of the disease have almost disappeared.
But the major shift in treatment regimens has brought new challenges as well.
The new drugs are immune suppressants that carry more serious side effects than earlier JIA treatments.
“People do die of infections when they’re on these drugs,” said Dr. Patience White, a medical professor at George Washington University in Washington, D.C., and a spokesperson for the Arthritis Foundation. “They’re a great thing but they do dampen your immune response.”
Short-term side effects, though usually considered a worthwhile tradeoff, raise questions about longer-term side effects. Because the biologic drugs are new, no one knows what consequences they may have for young patients after 10 or 20 years. The immune system plays a role keeping cancer at bay, for instance, and adults with rheumatoid arthritis face elevated risks of some types cancer.
Perhaps the greatest problem is that for some patients who are good candidates for these medications, the drugs remain out of reach. Most family doctors don’t know how to use biologics, according to White, because JIA is rare and the drugs are new.
Early intervention is key to protect joints from permanent damage, so families need to take affected children to a specialist right away. Yet, in at least 11 states there isn’t a single pediatric rheumatologist, according to Arthritis Foundation data.
Then there’s the issue of insurance coverage. Many insurers categorize biologics as specialty drugs, leaving families with high out-of-pocket costs.
“It’s a significant issue for families. To try to get these drugs for their kids, some have tried to sell their homes,” White said.
We should support the Arthritis Foundation’s lobbying efforts for expanded access to the new drugs.