Toxicity of antirheumatic medications in children with juvenile arthritis

Using patient related examples, the toxicity of nonsteroidal antiinflammatory drugs and disease modifying antirheumatic drugs (DMARD) in juvenile arthritis (JA) is discussed. DMARD combinations are also reviewed. Gastrointestinal side effects are not emphasized. Rather, central nervous system, hepatic, and renal effects are discussed. Ibuprofen is safer than aspirin and has a generally good record. Although data is not excellent and often relies on open studies, hydroxychloroquine is probably the safest DMARD. Methotrexate appears safe, but studies in adults mandate some continued caution in its use in children. Combination DMARD therapy, while used, is dependent on largely open or anecdotal data in adults. The efficacy and toxicity of DMARD combinations are not well understood.