Jennings Heidi, Hennessy Kym, Hendry Gordon J
School of Science & Health, University of Western Sydney, Penrith, NSW, Australia.
School of Science & Health, University of Western Sydney, Penrith, NSW, Australia ; Institute for Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK.
Pediatr Rheumatol Online J. 2014 Jun 11;12:23. doi: 10.1186/1546-0096-12-23. eCollection 2014.
Juvenile Idiopathic Arthritis (JIA) commonly affects joints of the lower limb including the knee, ankle, subtalar and other foot joints. Intra-articular corticosteroid injections (IACIs) are considered to be effective for short-term relief of synovitis, however, there appears to be a significant lack of published evidence from comparative effectiveness studies. The aim of this study was to identify and critically appraise the evidence for the efficacy of lower limb IACIs in children/adolescents with JIA.
Studies were identified in databases Medline, Embase, CINAHL, AMED, PEDro, the Cochrane Library and TRIP, with no date restrictions. The primary search terms 'juvenile idiopathic arthritis', 'lower limb', 'knee'; 'ankle', 'foot' and 'intra-articular steroid injections' and related synonyms were used to develop a comprehensive pragmatic literature search strategy. Included studies were quantitative longitudinal design such as randomised controlled trials, pseudo-randomised and non-randomised experimental studies, cohort studies, and case-control studies. All outcomes measures were subject to analysis. Quality assessment was conducted using the Cochrane Collaboration criteria with additional criteria for sample population representativeness, quality of statistical analysis and compliant intervention use and presence of co-interventions. Qualitative data synthesis was conducted for the outcome domains. Meta-analyses were not possible as multiple randomised controlled trials for outcome measures were not available. Levels of evidence were assigned to each outcome measure.
The inclusion criteria were met by twenty-one studies. One study had high quality for internal validity and nine studies had high quality for external validity. No studies had high quality for both internal and external validity. Four outcome domains were identified. There was weak evidence for IACIs decreasing clinical signs and symptoms in the lower leg, improving joint range of motion, decreasing leg length discrepancy, and for imaging techniques detecting the effects of IACIs.
There is some weak evidence for the efficacy of IACIs improving certain outcome measures. However, there is also some inconclusive evidence due to a lack of quality studies. More high quality evidence is necessary to definitely determine the efficacy of IACIs for JIA in the lower leg.
幼年特发性关节炎（JIA）通常会影响下肢关节，包括膝关节、踝关节、距下关节和其他足部关节。关节内注射皮质类固醇（IACIs）被认为对短期缓解滑膜炎有效，然而，比较有效性研究的已发表证据似乎明显不足。本研究的目的是识别并严格评估IACIs对JIA儿童/青少年下肢疗效的证据。
在Medline、Embase、CINAHL、AMED、PEDro、Cochrane图书馆和TRIP数据库中检索研究，无日期限制。使用主要检索词“幼年特发性关节炎”、“下肢”、“膝关节”、“踝关节”、“足部”和“关节内类固醇注射”以及相关同义词制定全面实用的文献检索策略。纳入的研究为定量纵向设计，如随机对照试验、半随机和非随机实验研究、队列研究和病例对照研究。所有结局指标均进行分析。采用Cochrane协作组标准进行质量评估，并附加样本代表性、统计分析质量、依从性干预使用情况和联合干预情况等标准。对结局领域进行定性数据综合分析。由于缺乏针对结局指标的多个随机对照试验，无法进行荟萃分析。为每个结局指标确定证据级别。
21项研究符合纳入标准。1项研究内部效度高，9项研究外部效度高。没有研究内部效度和外部效度均高。确定了四个结局领域。有微弱证据表明IACIs可减轻小腿的临床体征和症状、改善关节活动范围、减少腿长差异，以及影像学技术可检测IACIs的效果。
有一些微弱证据表明IACIs在改善某些结局指标方面有效。然而，由于缺乏高质量研究，也有一些不确定的证据。需要更多高质量证据来明确确定IACIs对JIA小腿的疗效。
