Cara was diagnosed with oligoarticular JIA

Cara, a 5-year-old girl who was diagnosed with oligoarticular JIA when she was a toddler, cringes when she walks outside in the sunlight and complains that she cannot see well. Her pediatric rheumatologist recently diagnosed her with uveitis, a common complication associated with JIA. Cara was initially prescribed oral methotrexate at a dose of 10 mg/m²weekly; however, her disease has progressed and become so debilitating that she now has trouble walking. Accordingly, her physician increased her dose of methotrexate to 15 mg/m²weekly and referred Cara to a pediatric physical therapist.

At Cara’s next visit, her erythrocyte sedimentation level (ESR) and C-reactive protein (CRP) levels both indicated increased disease activity. Her physician performed an active joint count (AJC) and surveyed Cara’s functional status using the Child Health Assessment Questionnaire (CHAQ). The tests also confirmed an increase in disease activity. Her pediatric rheumatologist prescribed a combination of oral methotrexate 15 mg/m² per week and adalimumab 15 mg to be injected every other week.

As Cara’s pharmacist, you review her current prescription and instruct her parents how to administer the medications. You discuss costs, safety issues, and adverse events relating to these medications.

Discuss Management Juvenile Idiopathic Arthritis (JIA) with DMARDs