Children with juvenile rheumatoid arthritis (JRA) are first treated with nonsteroidal anti-inflammatory drugs (NSAIDs) that often provide relief and reduce inflammation. NSAIDs are considered the first-line treatment for JRA. Second-line drug therapy—known interchangeably as disease-modifying antirheumatic drugs (DMARDs) and as slow-acting antirheumatic drugs (SAARDs)—for JRA may be recommended when a child continues to have joint pain, swelling, or both despite rest, exercise, use of NSAIDs, and physical therapy.

DMARDs/SAARDs include methotrexate, azathioprine, cyclosporine, etanercept, and sulfasalazine.

DMARDs/SAARDs have several characteristics in common.

• They are slow to take effect. It may take 8 to 24 weeks for the drug to show a benefit.
• They have a small risk of serious side effects (on blood cells, eyes, kidney, or liver). Side effects can be detected with close monitoring and are reversible if the drug is stopped.
• They have a moderate risk of side effects that may be uncomfortable but are not serious (nausea, skin rash, mouth sores, diarrhea, hair thinning).
• While these medicines offer effective treatment for many children, they are not a reasonable treatment option for others. Side effects, ineffectiveness, or both are common reasons that children are withdrawn from DMARD/SAARD treatment.
• NSAIDs are often used together with one of these medicines.

Although these medicines are often called "disease-modifying," it has been difficult to prove that they truly prevent long-term joint damage. But they often relieve pain and swelling.