The use of non-steroidal anti-inflammatory drugs in paediatric rheumatic diseases.
The use of NSAIDs for arthritis differs in children from adults in their indications, uses and pharmacokinetics, and fewer are available. Children with arthritis are assessed differently, as they complain less of pain. Salicylates, indomethacin and ibuprofen are used for the fever of systemic JCA. For control of joint symptoms, diclofenac, ibuprofen, tolmetin and naproxen are equal in their efficacy and tolerance:salicylates and indomethacin are no more effective but more toxic. Children tolerate NSAIDs well. Gastrointestinal symptoms appear to be less common than in adults, but the evidence regarding endoscopic changes in conflicting. Renal toxicity is rare. Tolmetin can cause pseudoproteinuria and naproxen pseudoporphyria. The liver in systemic JCA is vulnerable to drug toxicity. A therapeutic trial of an NSAID should continue for 8 weeks. Interactions with methotrexate and carbonic anhydrase inhibitors for glaucoma complicating iridocyclitis may occur.