Skip to main content


Log in

Decreased use of non-steroidal anti-inflammatory drugs for the treatment of juvenile idiopathic arthritis in the era of modern aggressive treatment

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript


We examined whether the use of non-steroidal anti-inflammatory drugs has decreased for the treatment of juvenile idiopathic arthritis in a cohort treated with aggressive modern therapy as well as potential factors influencing their use. We randomly sampled 100 of 377 patients with juvenile idiopathic arthritis treated by pediatric rheumatologists at our center between 2003 and 2008. We used electronic health records and detailed chart review to examine the trends of non-steroidal anti-inflammatory drug use and factors impacting use, including disease subtype, disease activity, adverse effects, and other medication use. Data were analyzed longitudinally using a non-linear mixed effects regression model. Ninety-two percent used non-steroidal anti-inflammatory drugs at some point and 70% at anti-inflammatory doses. At patients’ last visit within the study time frame, 52% were using non-steroidal anti-inflammatory drugs and only 28% at anti-inflammatory doses, decreased from 79 and 56%, respectively, at their first visit. In 2003, 53% used an anti-inflammatory dose compared to 35% in 2008. Active joint count was significantly associated with non-steroidal anti-inflammatory drug use at anti-inflammatory doses, while methotrexate and biologic modifiers use, later calendar year, the presence of uveitis, and positive anti-nuclear antibody status were significant negative predictors. The use of non-steroidal anti-inflammatory drugs decreased significantly over time, with decreasing numbers of active joints, and when methotrexate or biologic modifiers were used. The number of patients currently using non-steroidal anti-inflammatory drugs is less than reported in series from the 1990s.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Levinson JE, Wallace CA (1992) Dismantling the pyramid. J Rheumatol 19(suppl 33):6–10

    Google Scholar 

  2. Orozco-Alcala JJ, Baum J (1974) Treatment of juvenile rheumatoid arthritis—a world survey. J Rheumatol 1:187–189

    PubMed  CAS  Google Scholar 

  3. Mier R, Lovell D, Bowyer S, Passo M, Rennebohm R, Schikler K, Coates S (1996) Medication choices in juvenile rheumatoid arthritis. J Clin Rheumatol 2:262–267

    Article  PubMed  CAS  Google Scholar 

  4. Brunner HI, Kim KN, Ballinger SH, Bowyer SL, Griffin TA, Higgins GC, Mier R, Passo MH, Rennebohm R, Schikler K, Lovell DJ (2001) Current medication choices in juvenile rheumatoid arthritis II–update of a survey performed in 1993. J Clin Rheumatol 7:295–300

    Article  PubMed  CAS  Google Scholar 

  5. Cron RQ, Sharma S, Sherry DD (1999) Current treatment by United States and Canadian pediatric rheumatologists. J Rheumatol 26:2036–2038

    PubMed  CAS  Google Scholar 

  6. Wallace CA, Levinson JE (1991) Juvenile rheumatoid arthritis: outcome and treatment for the 1990s. Rheum Dis Clin North Am 17:891–905

    PubMed  CAS  Google Scholar 

  7. Woo P (2009) Theoretical and practical basis for early aggressive therapy in paediatric autoimmune disorders. Curr Opin Rheumatol 21:552–557

    Article  PubMed  CAS  Google Scholar 

  8. Hashkes PJ, Laxer RM (2005) Medical treatment of juvenile idiopathic arthritis. JAMA 294:1671–1684

    Article  PubMed  CAS  Google Scholar 

  9. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo Pl, International League of Associations for Rheumatology (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  10. Zak M, Pedersen FK (2000) Juvenile chronic arthritis into adulthood: a long-term follow-up study. Rheumatology 39:198–204

    Article  PubMed  CAS  Google Scholar 

  11. Guillaume S, Prieur AM, Coste J, Job-Deslandre C (2000) Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis. Arthritis Rheum 43:1858–1865

    Article  PubMed  CAS  Google Scholar 

  12. Minden A, Niewerth M, Listing J, Biedermann T, Bollow M, Schontube M et al (2002) Long-term outcome in patients with juvenile rheumatoid arthritis. Arthritis Rheum 46:2392–2401

    Article  PubMed  Google Scholar 

  13. Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Cheang M (2002) Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort. J Rheumatol 29:1989–1999

    PubMed  Google Scholar 

  14. Packham JC, Hall MA, Pimm TJ (2002) Long-term follow-up of 246 adults with juvenile idiopathic arthritis: predictive factors for mood and pain. Rheumatology 41:1444–1449

    Article  PubMed  CAS  Google Scholar 

  15. Foster HE, Marshall N, Myers A, Dunklet P, Griffiths ID (2003) Outcome in adults with juvenile idiopathic arthritis. A quality of life study. Arthritis Rheum 48:767–775

    Article  PubMed  Google Scholar 

  16. Fujikawa S, Okuni M (1997) Clinical analysis of 570 cases with juvenile rheumatoid arthritis: results of a nationwide retrospective survey in Japan. Acta Paediatr Jpn 39:245–249

    Article  PubMed  CAS  Google Scholar 

  17. Levy DM, Imundo LF (2010) Nonsteroidal anti-inflammatory drugs: a survey of practices and concerns of pediatric medical and surgical specialists and a summary of available safety data. Pediatr Rheumatol 8:7

    Article  Google Scholar 

Download references


Funding for this project was provided in part by the American College of Rheumatology Research and Education Foundation Abbott Medical Student Preceptorship Award.

Conflict of interest

The authors declare that they have no conflict of interests.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Philip J. Hashkes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kochar, R., Walsh, K.M., Jain, A. et al. Decreased use of non-steroidal anti-inflammatory drugs for the treatment of juvenile idiopathic arthritis in the era of modern aggressive treatment. Rheumatol Int 32, 3055–3060 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: