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

Rheumatol Int. 2011 Jun;31(6):749-56. doi: 10.1007/s00296-010-1365-x. Epub 2010 Feb 14.

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.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Antirheumatic Agents / administration & dosage
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use*
  • Appetite / drug effects
  • Arthritis, Juvenile / drug therapy*
  • Arthritis, Juvenile / physiopathology
  • Atrophy / chemically induced
  • Atrophy / pathology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cushing Syndrome / chemically induced
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Injections, Intra-Articular
  • Male
  • Range of Motion, Articular
  • Remission Induction
  • Retrospective Studies
  • Skin / drug effects
  • Skin / pathology

Substances

  • Antirheumatic Agents
  • Glucocorticoids