Odio Carla M, Ramirez Tobias, Arias Gloria, Abdelnour Arturo, Hidalgo Isabel, Herrera Marco L, Bolaños Willy, Alpízar Jorge, Alvarez Patricio
Infectious Diseases, Hospital Nacional de Niños, San Jose, Costa Rica.
Pediatr Infect Dis J. 2003 Oct;22(10):883-8. doi: 10.1097/01.inf.0000091293.32187.7b.
Septic arthritis is associated with residual dysfunction in 10 to 25% of affected children. Concentrations of cytokines detected in synovial fluid of children with bacterial arthritis correlate with the severity of inflammation. Treatment with dexamethasone decreased cartilage degradation in experimental Haemophilus influenzae b and Staphylococcus aureus arthritis.
To decrease the number of patients with residual dysfunction of the affected joint at the end of therapy and at 6 and 12 months and to speed clinical recovery by the administration of dexamethasone.
In a double blind manner we randomly selected 123 children with suspected hematogenous bacterial arthritis to receive dexamethasone or saline for 4 days. Antibiotic therapy was tailored according to age and the recovered pathogen.
Of the 123 children enrolled, 61 were assigned to the dexamethasone group and 62 to the placebo group. Only 50 and 50 patients in each group were evaluable. The 2 groups of patients were comparable with respect to age, sex, duration of symptoms, pathogen, affected joint and therapeutic and diagnostic procedures. Staphylococcus aureus accounted for 67% of the isolates, Haemophilus influenzae type b for 13% and Streptococcus pneumoniae for 9%. Dexamethasone therapy reduced residual dysfunction at the end of therapy, P = 0.000068; at 6 months, P = 0.00007; and at 12 months, P = 0.00053 of follow-up and shortened the duration of symptoms (P = 0.001) during the acute phase. The 26% incidence of residual dysfunction in the control patients was similar to the 25% found in other series.
A short course of dexamethasone reduced residual joint dysfunction and shortened significantly the duration of symptoms in children with documented hematogenous septic arthritis. These results suggest that a 4-day course of low dose dexamethasone given early benefits children with hematogenous septic arthritis.
在10%至25%的受影响儿童中，化脓性关节炎与残留功能障碍有关。在细菌性关节炎患儿的滑液中检测到的细胞因子浓度与炎症严重程度相关。地塞米松治疗可减少实验性b型流感嗜血杆菌和金黄色葡萄球菌关节炎中的软骨降解。
减少治疗结束时、6个月和12个月时受影响关节残留功能障碍的患者数量，并通过给予地塞米松加速临床恢复。
我们以双盲方式随机选择123例疑似血源性细菌性关节炎的儿童，给予地塞米松或生理盐水治疗4天。抗生素治疗根据年龄和分离出的病原体进行调整。
在纳入的123名儿童中，61名被分配到地塞米松组，62名被分配到安慰剂组。每组只有50名患者可进行评估。两组患者在年龄、性别、症状持续时间、病原体、受影响关节以及治疗和诊断程序方面具有可比性。分离出的病原体中金黄色葡萄球菌占67%，b型流感嗜血杆菌占13%，肺炎链球菌占9%。地塞米松治疗减少了治疗结束时的残留功能障碍，P = 0.000068；在6个月时，P = 0.00007；在12个月的随访时，P = 0.00053，并缩短了急性期症状持续时间（P = 0.001）。对照组患者26%的残留功能障碍发生率与其他系列研究中发现的25%相似。
短期使用地塞米松可减少有血源性化脓性关节炎记录的儿童的残留关节功能障碍，并显著缩短症状持续时间。这些结果表明，早期给予4天低剂量地塞米松疗程对血源性化脓性关节炎患儿有益。
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