Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era

Charalampia Papadopoulou, Mikhail Kostik, Maria Isabel Gonzalez-Fernandez, Marek Bohm, Juan Carlos Nieto-Gonzalez, Angela Pistorio, Stefano Lanni, Alessandro Consolaro, Alberto Martini, Angelo Ravelli

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To investigate the outcome and predicting factors of multiple intraarticular corticosteroid (IAC) injections in children with juvenile idiopathic arthritis (JIA). Methods The clinical charts of patients who received their first IAC injection in ≥3 joints between January 2002 and December 2011 were reviewed. The corticosteroid used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. In each patient, the followup period after IAC injection was censored in case of synovitis flare or at the last visit with continued remission. Predictors included sex, age at disease onset, JIA category, antinuclear antibody (ANA) status, age and disease duration, disease course, general anesthesia, number and type of injected joints, acute-phase reactants, and concomitant systemic medications. Results A total of 220 patients who had 1,096 joints injected were included. Following IAC therapy, 66.4% of patients had synovitis flare after a median of 0.5 years, whereas 33.6% of patients had sustained remission after a median of 0.9 years. The cumulative probability of survival without synovitis flare was 50.0%, 31.5%, and 19.5% at 1, 2, and 3 years, respectively. On Cox regression analysis, positive C-reactive protein value, negative ANA, lack of concomitant methotrexate administration, and a polyarticular (versus an oligoarticular) disease course were the strongest predictors for synovitis flare. Conclusion Multiple IAC injection therapy induced sustained remission of joint synovitis in a substantial proportion of patients. A controlled trial comparing multiple IAC injection therapy and methotrexate versus methotrexate and a tumor necrosis factor antagonist is worthy of consideration.

Original languageEnglish
Pages (from-to)1112-1120
Number of pages9
JournalArthritis Care and Research
Volume65
Issue number7
DOIs
Publication statusPublished - Jul 2013

ASJC Scopus subject areas

  • Rheumatology

Fingerprint Dive into the research topics of 'Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era'. Together they form a unique fingerprint.

Cite this