Q: My daughter is 19 years old and her weight is 45 kg. She is suffering from juvenile arthritis and also have a mild to moderate low back pain, which increases with stress like travelling and using computer over a long period. She is undergoing the treatment for the same and is taking Sazo 500 mg thrice a day, Neotrexate 2.5 mg, 1 tab alternate days with Folvite or Autrin. She does lot of strenuous work but the pain bothers her. Now her doctor is contemplating for iv remicade at 3mg/kg body weight within 0, 2 and 6 weeks under his supervision. She is not having any infection but her mother has a history of TB with ascites long before her birth and was fully cured after completing anti TB regimen. My daughter was also vaccinated with BCG after her birth. Please advise.

A:Juvenile arthritis is an umbrella term that encompasses seven categories of disease. What you seem to describe is axial or back pain in the child. Few points here 1. Methotrexate is to be given only once a week 2. The child should be on regular NSAIDs (Non-steroidal anti-inflammatory drugs) for the back pain 3. If on regular painkillers her BASDAI (Bath Ankylosing Spondylitis Disease Activity Index, a disease activity score) is more than 4 after 3 months, she is a candidate for TNF blockade. 4. The disease should be carefully assessed and monitored on a regular basis 5. The child will need screening for TB prior to starting the therapy