{ "schema_version": 1, "kind": "condition", "id": "juvenile-idiopathic-arthritis-referral", "name": "Juvenile idiopathic arthritis (referral)", "category": "chronic", "sources": "Juvenile Idiopathic Arthritis - StatPearls (NCBI Bookshelf NBK554605) - https://www.ncbi.nlm.nih.gov/books/NBK554605/ · Ibuprofen 100 mg/5 ml Oral Suspension SmPC section 4.2 (eMC product 4560) (juvenile rheumatoid arthritis dose) · Juvenile idiopathic arthritis - disease-level clinical article (juvenile-idiopathic-arthritis-referral-full.txt) · Juvenile idiopathic arthritis - disease-level clinical article (juvenile-idiopathic-arthritis-referral-clinical.txt)", "review_status": "reviewed", "verified_against": "Ibuprofen 100 mg/5 ml Oral Suspension SmPC section 4.2 (eMC product 4560) (juvenile rheumatoid arthritis dose) · Juvenile Idiopathic Arthritis - StatPearls (NCBI Bookshelf NBK554605) - https://www.ncbi.nlm.nih.gov/books/NBK554605/ · Juvenile idiopathic arthritis - disease-level clinical article (juvenile-idiopathic-arthritis-referral-full.txt)", "verified_date": "2026-09", "treatments": [ { "id": 1081, "generic": "Ibuprofen", "line": 1, "is_adjunct": false, "form": "oral.liquid", "strength_mg": 100.0, "adult_dose": "Not applicable - juvenile idiopathic arthritis is by definition a disease beginning under 16 years of age (see the paediatric dose)", "adult_duration": "Not applicable", "dose_source": "Ibuprofen 100 mg/5 ml Oral Suspension SmPC section 4.2 (eMC product 4560) for the juvenile arthritis amount: \"For Juvenile Rheumatoid Arthritis (prescription only use): Doses up to 30-40mg/kg/day may be taken in three or four divided doses.\" That an NSAID is the initial symptomatic treatment for every subtype comes from Juvenile Idiopathic Arthritis - StatPearls (NCBI Bookshelf NBK554605) - https://www.ncbi.nlm.nih.gov/books/NBK554605/", "rationale": "The article: \"Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of initial symptomatic treatment for all subtypes.\" It names no individual NSAID and states no amount, so the amount comes from the product licensed for juvenile rheumatoid arthritis - the anti-inflammatory dose, which is roughly twice the ordinary dose for pain and fever. This is what primary care can give while the rheumatology referral is arranged; it treats the symptoms and changes nothing about the disease.", "cautions": [ "No milligram ceiling is stated for this indication, and the calculated figure gets large in an older child. The same SmPC caps ordinary analgesic use in an adult at \"not more than 1200 mg (60 ml) in any 24 hour period\", and separately warns that \"use of Ibuprofen, particularly at a high dose (2400 mg/day) may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke)\". Those are an analgesic cap and a cardiovascular risk threshold, not a licensed maximum for juvenile arthritis - so where the weight-based figure above lands near or above them, agree the actual dose with the rheumatology team rather than using the calculated figure.", "This is symptom relief, not treatment of the disease. It does not remove the need for the referral and it does not slow joint damage.", "Usual NSAID precautions. Give it with food; avoid in active peptic ulceration, in a bleeding disorder, and in a dehydrated child; take care in asthma, and stop it if the child develops abdominal pain, black stools or a rash.", "RED FLAG - Do not let an NSAID mask a septic joint or a malignancy. A swollen joint plus fever, night pain, bruising or pallor is investigated before it is treated - the article's own differential for a few swollen joints includes septic arthritis, osteomyelitis, non-accidental injury, leukaemia, lymphoma and neuroblastoma." ], "peds_mgkg_low": 30.0, "peds_mgkg_high": 40.0, "peds_max_mg": null, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Divided into three or four doses across the day, as an anti-inflammatory rather than an analgesic amount - the same SmPC gives only 20 mg/kg/day in divided doses for ordinary pain and fever. The SmPC states no milligram ceiling for the juvenile arthritis dose, so none is applied here; see the cautions for what that means in a heavier child. Do not give ibuprofen to a child under 3 months.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 300, "high_mg": 400, "capped": false }, { "weight_kg": 20, "low_mg": 600, "high_mg": 800, "capped": false }, { "weight_kg": 30, "low_mg": 900, "high_mg": 1200, "capped": false }, { "weight_kg": 40, "low_mg": 1200, "high_mg": 1600, "capped": false } ], "brands": [ { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUPROFEN 100MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MARCOFEN 100MG/5ML SUSP. 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 5.85, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAFO 100MG/5ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUCALMIN 100MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 28.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "JUSPOLED 100MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > JASPER FOR PHARMACEUTICAL INDUSTRIES", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEGAFEN-N 100MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 35.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEN 100MG/5ML SYRUP 150ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 44.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "IBUFEN 2% SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "juvenile-idiopathic-arthritis-referral" }, { "id": 1082, "generic": "Referral & safety-netting (no drug therapy)", "line": 2, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "No dose - the referral threshold and the mimics to exclude, from Juvenile Idiopathic Arthritis - StatPearls (NCBI Bookshelf NBK554605) - https://www.ncbi.nlm.nih.gov/books/NBK554605/", "rationale": "A joint that has been swollen for six weeks in a child under 16 is a rheumatology referral, and the six weeks is the whole definition. Primary care's job is to reach that threshold without treating the child as a series of sprains, and to exclude infection and malignancy on the way. Disease-modifying therapy is specialist-initiated.", "cautions": [ "THE DEFINITION IS THE REFERRAL THRESHOLD - juvenile idiopathic arthritis (JIA) is a mixed group of inflammatory arthritides of unknown cause, arising in a child under 16 and running 6 weeks or more. Consider it in any child under 16 years whose arthritis has lasted at least six weeks, once the other causes of a chronic arthritis have been excluded.", "IT IS A DIAGNOSIS OF EXCLUSION, SO THE DANGEROUS MIMICS COME FIRST - because JIA is arrived at by ruling everything else out, any positive answer in the systems review has to be chased down as a possible disease in its own right. For a few swollen joints, the article's own list runs to infection in the joint or the muscle, osteomyelitis, sickle cell disease and haemophilia, injury that was not accidental, and the malignancies - a bone tumour, neuroblastoma, leukaemia, lymphoma. A child with a swollen joint and night pain, bruising or pallor is investigated for leukaemia before being labelled arthritic.", "AND FOR A FEVERISH CHILD WITH JOINTS, THE LIST IS DIFFERENT AGAIN - before systemic arthritis is accepted, exclude infection (mycoplasma, cat scratch disease, endocarditis, Lyme disease); acute rheumatic fever; PFAPA, that is periodic fever with mouth ulcers, sore throat and neck nodes; the other autoinflammatory syndromes; systemic vasculitis, meaning polyarteritis nodosa and Kawasaki disease; inflammatory bowel disease; and malignancy - leukaemia, lymphoma, neuroblastoma.", "WHAT THE JOINTS LOOK LIKE - JIA follows the usual pattern of an inflammatory joint disease: synovitis, an effusion, swelling of the soft tissue, thin bone, oedema within the bone, erosions. To that, a growing skeleton adds its own: growth at the epiphysis disturbed, a physis that fuses too soon, and limbs that end up different lengths. The wrists, the knees and the ankles are where it most typically sits.", "NO BLOOD TEST MAKES OR EXCLUDES THE DIAGNOSIS - nothing on the panel is specific, either for making the diagnosis or for judging how active the disease is. A positive rheumatoid factor or anti-CCP adds little diagnostically, though it does point to a rougher course and a worse outcome. What to send: a full blood count, ESR, CRP, antinuclear antibody, rheumatoid factor, anti-CCP antibodies, and HLA-B27.", "A NORMAL X-RAY EARLY ON MEANS NOTHING - the plain film is still where imaging starts for a painful joint, but early in JIA there is nothing on it to find. Ultrasound is the accessible next step: it shows the thickened synovium and the synovitis, which matters greatly for the diagnosis, and it can be done without sedating the child.", "WHAT PRIMARY CARE CAN OFFER WHILE THE REFERRAL IS ARRANGED - whatever the subtype, symptomatic treatment starts with a non-steroidal anti-inflammatory. The article names no individual NSAID and states no amount; the ibuprofen entry above carries the amount from the product licensed for juvenile rheumatoid arthritis, which is an anti-inflammatory dose and not the smaller one used for pain and fever.", "AND THE REST OF THE TREATMENT IS NOT A CLINIC DECISION - treating JIA takes drugs that damp inflammation and modulate the immune system, physiotherapy alongside them, and in time possibly an operation, help with nutrition, and psychosocial support. Reliance on NSAIDs has fallen away as treatment has grown more aggressive - methotrexate and the biologics.", "KEEP THE CHILD MOVING - physiotherapy works the joints through their range while loading them as little as possible, and swimming often suits that well. Moderate exercise for fitness, for suppleness and for strength is part of it.", "MACROPHAGE ACTIVATION SYNDROME IS THE ONE THAT KILLS - the most frightening complication of the lot, driven by T lymphocytes and macrophages activating and multiplying out of control. Nobody knows how often it happens in JIA, though some studies put it as high as 10% of cases. The tests it calls for are ferritin, fibrinogen, AST and triglycerides.", "THE LONG-TERM DAMAGE IF IT DRIFTS - the two seen most are legs of unequal length and a contracted joint. Others that matter: growth held back, bone mineral density below what the child's age should give, hips damaged badly enough to need replacing, and amyloidosis.", "WHICH IS WHY THE REFERRAL IS URGENT RATHER THAN ROUTINE - diagnosing and treating this quickly, and correctly, is what keeps a joint from being damaged for good and keeps it working.", "EYE INVOLVEMENT - ASK THE RHEUMATOLOGIST TO ARRANGE THE EYE REVIEW. The cached article records genetic ground shared by JIA and uveitis, naming HLADRB1:11 and HLADRB1:13 as linked to uveitis, and it reports uveitis commonest in northern and southern Europe and least common in Latin America, in Africa, in the Middle East and in Southeast Asia. It sets out no screening interval and no examination method, so no schedule is printed here; the interval comes from the specialist who takes the child on." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "juvenile-idiopathic-arthritis-referral" } ] }