Intra-articular corticosteroid therapy for juvenile idiopathic arthritis: report of an experiential cohort and literature review
Department of Pediatrics
Medical Subject Headings
Adolescent; Antirheumatic Agents; use; Appetite; Arthritis, Juvenile Rheumatoid; Atrophy; Child; Child, Preschool; Cohort Studies; Cushing Syndrome; Female; Glucocorticoids; Humans; Injections, Intra-Articular; Male; Range of Motion, Articular; Remission Induction; Retrospective Studies; Skin
Pediatrics | Rheumatology
The objective of the study to review an experiential cohort of patients receiving IACS and review the associated literature. Review of 121 IACS in 61 patients with JIA. At 3-month intervals, injected joints were evaluated for swelling and range of motion, and the patient and parent were questioned regarding associated pain and morning stiffness. Data were analyzed by log-rank analysis according to injected corticosteroid preparation and its dosage. Adverse events were also recorded. A thorough literature search was done for the literature review. Mean duration of response was 12.5 months (52% of joints in remission at 1 year, 20% after 2 years, and 7% after 3 years). Response was longer with at least 1 mg/kg of corticosteroid, with the longest responses seen with triamcinolone hexacetonide (THA)>triamcinolone acetonide>methylprednisolone. Adverse events were cutaneous atrophy at three injections sites (2.5%), and transient Cushingoid habitus and increased appetite in two patients (3%). Review of the literature generated similar responses to those included herein. Thus, there have been several recommendations for IACS to be a major JIA treatment, and surveys now demonstrate a high level of usage by pediatric rheumatologists. In conclusion the use of IACS in JIA substantiated. THA at a dose of 1-1.5 mg/kg is ideal.
Rights and Permissions
Citation: Rheumatol Int. 2011 Jun;31(6):749-56. Epub 2010 Feb 14. Link to article on publisher's site