Understanding JIA: how treatments have changed from youth to senior age

Juvenile idiopathic arthritis is often seen as a condition that affects children, but it can continue into adulthood and even senior years. This condition, which starts before age 16, can keep affecting individuals throughout their lives, meaning ongoing management and changing treatment strategies are needed.

Over the past 20 years, advancements in JIA treatment have improved outcomes not just for kids, but also offer hope for seniors who have lived with this condition for many years. Switching from traditional drugs to more targeted treatments, like biologic therapies and JAK inhibitors, is a significant step forward in caring for people with ongoing inflammatory issues like JIA.

Persistent challenges of JIA in adulthood

JIA can present special challenges as you get older. For some, symptoms like joint pain, stiffness, and inflammation stick around into adulthood, needing constant management. Unlike some illnesses that go away completely, JIA often requires ongoing treatment, with many experiencing bouts of active disease or flares even in old age.

This ongoing management can impact physical health and life quality, especially when mixed with natural aging and other health issues. That’s why it’s important for older adults with JIA to have access to new treatment options.

From 2000 to 2022, the use of traditional drugs like methotrexate and hydroxychloroquine for JIA dropped significantly. This change happened because targeted biologic drugs became more popular. These drugs are made to block specific parts of the immune system involved in arthritis.

At first, TNF inhibitors, such as etanercept and adalimumab, were the main choice. By 2008, TNF inhibitors were the most used drugs for JIA. However, by 2022, there were even more targeted treatments available, and these newer options began to replace TNF inhibitors.

JAK inhibitors are a good example of this shift. These drugs provide another option for those who don’t respond well to biologic drugs. Tofacitinib, a JAK inhibitor, was used for adult rheumatoid arthritis in 2012 and was approved for JIA in 2020. These advancements are encouraging for adults and seniors still dealing with symptoms from their younger years. While adalimumab is still widely used for JIA, newer drugs like abatacept, secukinumab, and rituximab are also becoming common.

Updated guidelines prioritize patient involvement

The American College of Rheumatology has been updating its guidelines to keep up with new advances in treating JIA. In the past, they mostly recommended using non-steroidal anti-inflammatory drugs and corticosteroids. But now, the focus is more on using biologics and including the patient in treatment decisions.

The goal is to cut down on the long-term use of steroids, which can have serious side effects as you get older. People who have lived with JIA know well these side effects, like gaining weight, weaker bones, and a higher chance of heart issues.

The updated ACR guidelines, which came out in 2022, encourage starting treatment early and being proactive. There’s more and more evidence that starting biologic treatments early can better control the disease and help stop long-term joint damage. For older adults who had JIA since childhood, these new treatments might help them reach remission or greatly improve their quality of life.

Focusing on making treatment decisions together with your doctor is key, especially for seniors. Customized care plans should consider your past treatments, how severe your disease is, and any other health issues you might have.

Involving patients and caregivers in making these decisions ensures everyone understands the benefits and risks of each treatment. This is extra important for seniors who might have other health challenges and need to see how JIA treatment fits with other medications or issues.

The new guidelines also stress the importance of non-drug treatment methods for older adults with JIA. Physical therapy, regular exercise, and keeping a healthy weight are essential. Exercise helps keep your joints flexible and your muscles strong, which is important as seniors might have reduced mobility. Occupational therapy offers ways to make daily activities easier on painful or stiff joints, improving overall function and quality of life.

Infection risks of biologic drugs

While biologic therapies and JAK inhibitors can help manage JIA better, they do come with risks. One big concern is a higher chance of infections. Seniors, who might have weaker immune systems, need to weigh these benefits and risks carefully. Biologic drugs like etanercept and tocilizumab help by reducing inflammation, but they can also make it easier to catch infections such as colds or, in rare cases, tuberculosis.

There’s also a debate about whether using biologics for a long time might increase cancer risk. Chronic inflammation might raise the chance of some cancers, and taking drugs that suppress the immune system can add to this worry. However, research hasn’t shown a clear rise in cancer for JIA patients on biologics. For seniors who have used these treatments for years, it’s essential to have regular health check-ups and talk to their doctors about any worries.

Impact of long-term inflammation

For seniors with JIA, it’s important to think about how long-term inflammation affects overall health. Ongoing inflammation can lead to issues beyond joints, like heart disease, weak bones, and metabolic syndrome. These problems can seriously affect quality of life and increase disability risks. To avoid these complications, managing inflammation through proper treatment is crucial for staying healthy.

Don’t forget about the emotional impact of living with JIA for so many years. Seniors who have had JIA since they were young might feel frustrated or tired from dealing with a chronic illness for such a long time. It’s common for people with long-term illnesses to feel depressed or anxious, and getting older can make these feelings worse.

Having access to mental health support, such as counseling and support groups, can help older adults manage the emotional side of JIA. Taking care of mental health is an essential part of managing JIA effectively in seniors.

Pain management and integrative approaches

Pain management is a crucial part of care for seniors with JIA. Chronic pain can affect your daily activities and happiness. Non-opioid pain relievers like acetaminophen, and creams or ointments can help with mild to moderate pain. For more intense pain, doctors might suggest low-dose opioids.

However, these should be used with care because of the risk of addiction and other side effects, especially in older adults. Other helpful methods include acupuncture and mindfulness practices, which can assist in easing chronic pain and enhancing your quality of life.

The importance of social support

Social support is crucial in managing JIA as you get older. If you’ve lived with JIA since childhood, having support from family, friends, or community groups can make a big difference. This support can help lift the emotional weight of the disease and offer practical help with everyday tasks. Staying connected with others and taking part in social activities can also boost your mental health and overall happiness.

To sum up, JIA treatment has improved dramatically over the last 20 years. We’ve moved from old drugs to more targeted biologic therapies. If you’ve had JIA since childhood, these advancements mean better ways to handle your condition and enhance your well-being.

Living with JIA into your senior years means you need a broad approach. It’s important to focus on the physical challenges but also the emotional and social ones. While living with JIA might be a lifelong journey, new treatments and a holistic care approach are making it easier than ever to manage the disease.