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When your child is diagnosed with a rheumatic disease and prescribed long-term medication, it is natural to feel a mix of concern and relief. You want your child to feel better, but you may also wonder about the side effects of these medications. This guide is here to help you better understand what to expect, what to watch for, and how to find peace of mind while supporting your child’s treatment.
Why Medication Is Important
Medications used in pediatric rheumatology are designed to control inflammation, prevent joint or organ damage, and allow children to live active, full lives. Without them, many children would experience persistent pain, fatigue, and disability. When prescribed and monitored properly, these medications are safe and effective. The most commonly used drug groups include:
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like ibuprofen or naproxen
• Corticosteroids, such as prednisone
• DMARDs (Disease-Modifying Anti-Rheumatic Drugs) like methotrexate
• Biologic therapies, such as TNF, IL-1, or IL-6 inhibitors
Each group has its benefits and potential side effects, and doctors carefully select and adjust treatments based on your child’s needs and how their body responds.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs are often among the first medications used in pediatric rheumatology for conditions such as juvenile idiopathic arthritis. Children typically tolerate NSAIDs well.
Common mild side effects:
• Stomach discomfort, nausea, or heartburn, usually mild and transient.
• These symptoms often improve when the medicine is taken with food or if a different NSAID is used.
Rare but serious side effects:
• Gastrointestinal bleeding or ulcers (indicated by black stools or persistent stomach pain), though these are rare in children.
• Kidney effects, especially in children with preexisting conditions.
• Slight effect on blood clotting, though generally not problematic in pediatric patients.
Duration and management:
• Mild side effects often resolve over time.
• More serious reactions can be treated and usually reverse once the drug is stopped.
Corticosteroids
Corticosteroids like prednisone are powerful anti-inflammatories. Used for severe or active disease phases, they offer quick symptom relief.
Common side effects with longer-term use:
• Increased appetite and weight gain, round face (“moon face”), mood swings, and sleep issues.
• Temporary growth delay in some children.
• Acne and increased hair growth in adolescents.
Infection risk:
• Steroids mildly suppress the immune system, so prompt attention is needed for infections like chickenpox.
Other possible effects:
• Bone mineral loss (osteoporosis), managed with calcium and vitamin D.
• Rarely, vision problems or elevated blood sugar.
Management:
• Side effects typically improve with dose reduction.
• Never stop steroids abruptly—dosage must be tapered.
DMARDs (Disease-Modifying Anti-Rheumatic Drugs)
Methotrexate is the most commonly used DMARD. Taken weekly, it helps control inflammation and prevent damage.
Common side effects:
• Mild nausea the day after dosing.
• Prevented or reduced with folic acid and anti-nausea medications.
Other possible reactions:
• Mouth ulcers or rashes, reversible with dose changes.
• Rare lung symptoms (persistent cough).
Laboratory monitoring:
• Regular blood tests help detect mild, reversible changes in liver function or blood counts.
• Serious side effects are rare in children.
Infection risk:
• Only slightly increased; most children on methotrexate handle infections normally.
Biologic Therapies
Biologic medications are targeted treatments used when conventional therapies are insufficient.
Most common side effect:
• Mild redness or swelling at the injection site.
Infusion reactions:
• Some biologics are given by IV. Mild allergic reactions can occur and are managed with slower infusions and pre-medication.
Infection risk:
• Biologics may increase susceptibility to specific infections, especially TB.
• Screening is done prior to starting therapy.
Other rare side effects:
• Unusual autoimmune responses or skin rashes.
• No clear evidence of increased cancer risk in children.
Special Considerations for Teens and Young Adults
Sexual Health and Fertility
As children grow into adolescence, conversations around sexual health become more relevant. Some medications, such as methotrexate, can be harmful to a developing fetus and must not be taken during pregnancy. It is important for sexually active teenagers to use effective contraception while on medications that could affect fertility or harm an unborn baby. This applies to both girls and boys, as methotrexate can also affect sperm.
Open conversations—with healthcare professionals and between parents and teens—can help ensure safe, informed decisions. Pediatric rheumatology teams are accustomed to addressing these topics sensitively and respectfully.
Reassurance About Pregnancy Outcomes
For young women with pediatric-onset rheumatic diseases, many successful pregnancies have been documented. With careful planning and proper medical guidance, most young people with rheumatic conditions can have healthy pregnancies. The key is to ensure the disease is well-controlled and to work closely with both a rheumatologist and obstetrician throughout the process.
Alcohol and Medication Safety
As teenagers become more independent, questions about alcohol use may arise. It is important to know that alcohol can interact with certain medications—especially methotrexate—and increase the risk of liver damage. In addition, alcohol can worsen side effects such as stomach irritation from NSAIDs or affect judgment and adherence to medication schedules.
A general recommendation is to avoid alcohol entirely while on immunosuppressive or liver-metabolized medications. If your teen is approaching adulthood, talk with their doctor about how to approach this topic responsibly.
The Role of Your Family Doctor (GP)
While your child’s rheumatologist leads their specialized care, the family doctor or GP remains an important partner. The GP can help monitor general health, administer routine vaccinations, assist in managing minor illnesses, and provide referrals or support in emergencies. A strong partnership between the rheumatologist and GP helps ensure that your child receives coordinated and comprehensive care.
Encourage regular visits to your GP, even if your child’s primary rheumatology treatment continues in a specialized center. It’s helpful to keep the GP informed about medications and treatments, so they can make the best decisions when needed.
What Parents Should Watch For
Expected side effects:
• Temporary nausea or fatigue
• Redness at injection site
• Mild mood changes with steroids
Call your doctor if you see:
• High fever
• Vomiting, black stools, or blood in vomit
• Unusual bruising or prolonged bleeding
• Breathing difficulties
• Persistent cough or behavior changes
Supporting Your Child at Home
• Learn about the medications your child takes and ask questions.
• Keep a treatment journal.
• Communicate openly with your child.
• Attend all monitoring visits and tests.
• Encourage healthy routines: sleep, nutrition, and physical activity.
• Avoid excessive online searching—trust your medical team.
Reassurance for the Journey Ahead
Rheumatologic diseases may require long-term treatment, but these therapies help your child live a full life. Side effects are usually manageable, and your care team is here to monitor and guide you. With early recognition, even rare complications can be treated effectively.
Stay observant, stay calm—and know that with teamwork and trust, your child can thrive.
Source: This summary is based on patient education materials from PRINTO (Pediatric Rheumatology International Trials Organisation). You can learn more at:
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