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Factors influencing the efficacy of intra-articular steroid injections in patients with juvenile idiopathic arthritis.

AbstractA retrospective chart review was performed of all patients with juvenile idiopathic arthritis (JIA) followed at our clinic who had an intra-articular steroid injection between 1 January 1997 and 31 December 2001. The aim of the study was to evaluate the outcome of intra-articular steroid injections (iaS) and determine prognostic factors. During the study period, 202 iaS were performed in 60 patients, of whom 37 had oligoarticular JIA, 15 had polyarticular, rheumatoid factor-negative JIA and four each had systemic and enthesitis-related JIA. The median duration of remission was 23.1 months (range: 0-69 months). At last follow-up, 103 joints (51%) of 47 patients were still in remission after a median follow-up time of 28 months (range: 1-69 months). For the total cohort, the remission was longer for wrist and finger joints [risk ratio (RR): 0.2], with concomitant treatment with methotrexate (RR: 0.28) and for enthesitis-related arthritis (RR: 0.34). For the group of knee joints, remission was longer with concomitant treatment with methotrexate (RR: 0.37), with triamcinolone hexacetonide (RR: 0.77) and with general anaesthesia for the procedure (RR: 0.56). Mild side effects were observed in 45 iaS (22.3%), and skin atrophy occurred at the injection site in 2% of injections, but no major adverse event occurred in our cohort. In conclusion, iaS is a safe procedure with a median duration of remission of 23.1 months. The remission was longer in the joints of the upper extremity, with concomitant treatment with methotrexate and when the injection was performed under general anaesthesia.
AuthorsPeter Marti, Luciano Molinari, Isabel B Bolt, Reinhard Seger, Rotraud K Saurenmann (Affiliation: Department of Paediatrics, University Children's Hospital, Zurich, Switzerland.)
JournalEuropean journal of pediatrics (Eur J Pediatr) Vol. 167 Issue 4 Pg. 425-30 (Apr 2008) ISSN: 0340-6199 Germany
PMID17562077 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Glucocorticoids
Topics
  • Adolescent
  • Arthritis, Juvenile Rheumatoid (drug therapy)
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Glucocorticoids (administration & dosage)
  • Humans
  • Infant
  • Injections, Intra-Articular
  • Male
  • Remission Induction (methods)
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome