Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy.
Rheumatology (Oxford). 2011 Sep;50(9):1627-34. doi: 10.1093/rheumatology/ker165. Epub 2011 May 11.
To investigate the efficacy of IA CS (IAC) therapy in single and multiple joints in children with JIA and to seek for predictors of synovitis flare.
The clinical charts of patients who received their first IAC injection between January 2002 and December 2008 were reviewed. The CS used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. Patients were stratified as follows: one joint injected; two joints injected; and three or more joints injected. Predictors included sex, age at disease onset, JIA category, age and disease duration, ANA status, iridocyclitis, general anaesthesia, number and type of injected joints, acute-phase reactants and concomitant MTX therapy.
The cumulative probability of survival without synovitis flare for patients injected in one, two, or three or more joints was 70, 45 and 44%, respectively, at 1 year; 61, 32 and 30%, respectively, at 2 years; and 37, 22 and 19%, respectively, at 3 years. On Cox regression analysis, positive CRP, negative ANA and injection in the ankle were the strongest predictors for synovitis flare. The only significant side effect was skin hypopigmentation or s.c. atrophy, which occurred in <2% of patients.
IAC therapy-induced sustained remission of synovitis in a substantial proportion of patients injected either in single or multiple joints, with a good safety profile. The risk of synovitis flare was higher in patients who had positive CRP, negative ANA and were injected in the ankle.
研究 IA CS（IA 皮质类固醇）治疗幼年特发性关节炎（JIA）单关节和多关节的疗效，并寻找滑膜炎发作的预测因素。
回顾了 2002 年 1 月至 2008 年 12 月期间首次接受 IA 注射的患者的临床病历。使用的 CS 为曲安奈德（triamcinolone hexacetonide）治疗大关节，甲泼尼龙醋酸酯（methylprednisolone acetate）治疗小关节或难以触及的关节。患者分层如下：注射一个关节；注射两个关节；注射三个或更多关节。预测因素包括性别、发病年龄、JIA 类别、年龄和病程、ANA 状态、虹膜炎、全身麻醉、注射关节的数量和类型、急性期反应物和同时使用 MTX 治疗。
注射一个、两个或三个或更多关节的患者，1 年时无滑膜炎发作的累积生存率分别为 70%、45%和 44%；2 年时分别为 61%、32%和 30%；3 年时分别为 37%、22%和 19%。Cox 回归分析显示，CRP 阳性、ANA 阴性和踝关节注射是滑膜炎发作的最强预测因素。唯一显著的副作用是皮肤色素减退或皮下萎缩，<2%的患者出现这种情况。
IA 皮质类固醇治疗在注射单关节或多关节的患者中，有相当一部分患者能诱导滑膜炎持续缓解，且安全性良好。CRP 阳性、ANA 阴性和踝关节注射的患者滑膜炎发作的风险更高。
