关节内注射曲安奈德己酮和曲安奈德治疗寡关节型幼年特发性关节炎的疗效。
Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis.
机构信息
Department of Pediatrics, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA.
Department of Pediatric Rheumatology, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA.
出版信息
Pediatr Rheumatol Online J. 2021 Mar 20;19(1):36. doi: 10.1186/s12969-021-00520-6.
BACKGROUND
Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection.
METHODS
Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children's Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA.
RESULTS
Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted.
CONCLUSION
Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.
背景
寡关节型幼年特发性关节炎（寡关节型 JIA）是幼年特发性关节炎中最常见的亚型。关节内皮质类固醇（IAC）注射是治疗寡关节型 JIA 的主要方法，可缓解疼痛、改善活动能力，并防止大多数患者的关节进一步破坏。2015 年，美国停止了曲安奈德己酮（TH）关节内皮质类固醇的生产，导致曲安奈德（TA）作为替代品使用。在这项研究中，我们比较了接受关节内 TA 和 TH 注射治疗的寡关节型 JIA 患儿的治疗反应。
方法
我们的研究是对 2012 年 1 月至 2015 年 6 月期间接受 TH 关节内注射和 2015 年 7 月至 2018 年 12 月期间接受 TA 关节内注射的寡关节型 JIA 患儿进行的回顾性图表审查。两组均在布法罗约翰·R·奥希什儿童医院进行随访，评估治疗反应、副作用和反应预测因素，包括治疗前疾病持续时间、红细胞沉降率（ESR）和 C 反应蛋白（CRP）。治疗反应定义为至少 6 个月的随访期内，注射关节无活动性关节炎证据。如果患者在关节注射后的首次随访中仍出现活动性关节炎，则被认为是无反应者。主要目的是评估 TH 和 TA 之间的反应率是否存在显著差异。
结果
研究纳入了 49 名寡关节型 JIA 患儿，其中 38 名女性，11 名男性，平均年龄为 6.7 岁。共注射了 111 个关节，包括 78 个膝关节、13 个踝关节、9 个腕关节、4 个髋关节、4 个肘关节、2 个 TMJ 和 1 个跗跖关节。在 TA 组中，49%（29/59）的患者对注射无反应，而 TH 组为 27%（14/52）。6 个月后，TH 组的反应率优于 TA 组（73% vs. 51%）。一般来说，TH 关节内注射的反应优于 TA，卡方检验独立性检验 P 值为 0.016。这种结果差异不受其他变量的影响，如治疗前疾病持续时间（P 值 0.784）或 ESR 和 CRP 升高。两组间的副作用无差异。
结论
我们的结果与先前发表的数据表明，TH 关节内注射治疗寡关节型 JIA 优于 TA，尽管需要进一步的对照试验来证实。有效的、持久的治疗可以对这些儿童的预后产生重大影响。
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