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104 Arthritis
Pediatric: NSAID (e.g. liquid naproxen 10 mg/kg BID)
Special cases:
n infectious arthritis ruled out with certainty: intra-articular injection of
corticosteroid (e.g. methylprednisolone 10–40 mg depending on joint
size)
n contraindications to NSAIDs and glucocorticoids: short-course acetaminophen
(650–1000 mg PO QID) with a mild opioid (e.g. tramadol 25–50 mg
PO QID)
RHEUMATOID AND JUVENILE RHEUMATOID ARTHRITIS
First line: NSAID (e.g. diclofenac 25–50 mg PO TID)
Reasonable:
n acetaminophen (650–1000 mg PO QID)
n acetaminophen (650–1000 mg PO QID) combined with tramadol (25–50 mg
PO QID)
Pregnancy:
n acetaminophen (650–1000 mg PO QID)
n prednisone (1 mg/kg PO QD)
n Intra-articular corticosteroid injection (if infection is ruled out) is performed
at the Massachusetts General Hospital for pregnant patients
Pediatric: NSAID (e.g. naproxen 10 mg/kg PO BID)
Special cases:
n infectious arthritis ruled out with certainty: intra-articular injection of
corticosteroid (e.g. methylprednisolone 10–40 mg depending on joint
size)
n contraindications to NSAIDs and glucocorticoids: short-course acetaminophen
with a mild opioid (e.g. tramadol 25–50 mg PO QID)
n high risk of GI bleeding: short-course COX-2 selective NSAID therapy (e.g.
celecoxib 200 mg PO BID)