Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, New York, USA.
J Rheumatol. 2012 Feb;39(2):374-6. doi: 10.3899/jrheum.110125. Epub 2011 Dec 1.
To determine whether the intraarticular (IA) dose of triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA) influences time to relapse among patients with juvenile idiopathic arthritis (JIA).
The primary endpoint variable was the time to relapse of arthritis in the affected joint after an intraarticular (IA) injection. A relapse was defined as the reoccurrence of active arthritis in the injected joint. Analysis was carried out including only the first IA joint injection for each patient. Further analysis was conducted including the first knee injection alone. A separate analysis within the IA corticosteroid groups was performed using the Spearman rank coefficient, to determine if dose of IA steroid affected time to relapse.
Records from 186 patients with JIA (145 females, 41 males) injected with either TH or TA were collected from January 1995 through December 2003. All subjects were followed for a minimum of 15 months from the time of IA injection. Of the 794 joint injections, 422 (53.1%) were injected with TH and 372 (46.9%) with TA. There were 111 first joint injections (all joints) with TH and 70 with TA. There were 89 first joint injections (knee only) with TH and 56 with TA. TH proved more effective than TA with respect to the time to relapse for first injection into all joints (10.47 ± 0.42 mo vs 8.66 ± 0.59 mo; p < 0.001), and for first injections into knee only (11.04 ± 0.44 vs 8.99 ± 0.65 mo; p < 0.001). IA doses ranged from 0.4 to 4 mg/kg (mean 1.56 ± 0.76) for TH and from 0.5 to 8 mg/kg (mean 2.54 ± 1.74) for TA. There was no correlation between time to relapse and dose of either TH and TA (r = 0.1, p > 0.5). There was no correlation between time to relapse and sex, duration of illness, age of patient, concurrent medications, or subtype of JIA.
In a larger dataset (794 injections) we have confirmed our previous findings (227 injections) that TH is a more effective IA corticosteroid than TA. In this much larger data analysis, dose of IA corticosteroid in the range we studied did not significantly influence the duration of response.
确定关节内（IA）注射曲安奈德己酮（TH）或曲安奈德（TA）的剂量是否会影响幼年特发性关节炎（JIA）患者的关节炎复发时间。
主要终点变量是 IA 注射后受累关节关节炎复发的时间。复发定义为注射关节再次出现活动性关节炎。分析仅包括每位患者的第一次 IA 关节注射。进一步分析仅包括第一次膝关节注射。在 IA 皮质类固醇组内进行单独分析，使用 Spearman 秩相关系数确定 IA 类固醇剂量是否影响复发时间。
1995 年 1 月至 2003 年 12 月期间，从接受 TH 或 TA 注射的 186 例 JIA 患者（145 名女性，41 名男性）的记录中收集了数据。所有患者均在 IA 注射后至少随访 15 个月。在 794 次关节注射中，422 次（53.1%）注射了 TH，372 次（46.9%）注射了 TA。TH 有 111 次首次关节注射（所有关节），TA 有 70 次。TH 有 89 次首次膝关节注射（仅膝关节），TA 有 56 次。TH 在首次注射所有关节（10.47±0.42 个月 vs 8.66±0.59 个月；p<0.001）和首次注射膝关节（11.04±0.44 个月 vs 8.99±0.65 个月；p<0.001）方面均优于 TA。IA 剂量范围为 TH 0.4 至 4mg/kg（平均 1.56±0.76），TA 0.5 至 8mg/kg（平均 2.54±1.74）。TH 和 TA 的复发时间与剂量之间均无相关性（r=0.1，p>0.5）。复发时间与性别、疾病持续时间、患者年龄、同时使用的药物或 JIA 亚型均无相关性。
在一个更大的数据集（794 次注射）中，我们证实了之前（227 次注射）的发现，即 TH 是一种比 TA 更有效的 IA 皮质类固醇。在这项更大的数据分析中，我们研究范围内的 IA 皮质类固醇剂量并未显著影响反应持续时间。
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