Heat and cold- Whether to use hot or cold applications on affected joints depends on the type of arthritis present and the recommendation of your child's physician. Pain relief may be obtained temporarily by using moist heat (warm bath or shower) or dry heat (heating pad) on the joint. If using a heating pad, place a towel between the heating pad and the skin, and check frequently to prevent burns.

Pain relief may also be obtained by placing an ice pack wrapped in a towel on the joint. Cold applications help reduce swelling, as well. However, children who have poor circulation should not use ice packs. Consult you child's physician regarding the type of application and application time before use.

Joint immobilization- The use of a splint or brace can help a joint rest and protect it from further injury. Walking devices, such as canes, crutches, and assistive devices with extra large or longer handles help keep stress off certain joints.

Massage- The light stroking and/or kneading of painful muscles may increase blood flow and bring warmth to the muscle.

Medications- There are several types of medications that may be used long-term to reduce pain and symptoms, including:

• Nonsteroidal anti-inflammatory medications (NSAIDS)- These medications, such as aspirin and ibuprofen, help reduce pain and inflammation.
• Disease-modifying anti-rheumatic medications- These prescription medications may affect the course of the disease by slowing down its progress and influence and/or correcting immune system abnormalities that are linked to the disease. Examples of disease-modifying anti-rheumatic medications are methotrexate and hydroxychloroquine.
• Biologics- A new form of therapy directed at inhibiting biologic inflammatory factors. Examples of biologics are TNF inhibitors.
• Cortiocosteriods-Cortiocosteriods are medications that contain hormones to treat rheumatic diseases. These medications, such as prednisone, can be taken orally or as an injection.

Exercise- Certain exercises, such as swimming, walking, low-impact aerobic exercise, and range-of-motion exercises, may help reduce joint pain and stiffness. Stretching exercises may be helpful in keeping the joints flexible.

Surgery- In severe cases of rheumatic disease, surgery may be necessary to repair or replace a joint. There are two main types of surgery for pediatric arthritis and other rheumatic disease:

• Repair- surgery to repair a damaged joint may include removing debris in the joint, fusing bones, or correcting a bone deformity.
• Replace- if a joint is too damaged for repair, it may need to be replaced with an artificial joint.