Title

Intra-articular corticosteroid therapy for juvenile idiopathic arthritis: report of an experiential cohort and literature review

UMMS Affiliation

Department of Pediatrics

Date

6-2011

Document Type

Article

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

Disciplines

Pediatrics | Rheumatology

Abstract

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

Related Resources

Link to Article in PubMed

PubMed ID

20155422