Division of Pediatric Rheumatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Division of Pediatric Rheumatology, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey.
Clin Rheumatol. 2022 Dec;41(12):3791-3796. doi: 10.1007/s10067-022-06327-4. Epub 2022 Aug 11.
Intra-articular corticosteroid injection (IACI) is generally used in the management of juvenile idiopathic arthritis (JIA) to obtain rapid relief of active synovitis and functional recovery and to prevent the need for regular systemic therapy. The aim of this study was to investigate the outcome of IACI treatment and the factors associated with remission of synovitis.
The clinical records of JIA patients who received IACI between January 2014 and December 2020 in two pediatric rheumatology centers were reviewed. The procedure was evaluated in terms of efficacy, factors that may affect the duration of remission, procedural and drug-related complications.
During the study period, 134 patients received 227 injections and 37 joints were injected more than once. One hundred and six (79%) patients had persistent oligoarticular disease. At the time of injection, all patients were receiving non-steroidal anti-inflammatory drugs, 74 patients were on methotrexate, and 14 patients were on biologics. The median duration of remission without exacerbation of synovitis treated with IACI was 15 (range 1-64) months. The inactivity rate was 81% at the 6th month after the injection. It has been shown that being less than 7 years old at disease onset and low initial CRP levels were correlated with a long remission period (p < 0.05). Despite the differences were not statistically significant, the duration of remission was longer in boys, in ANA positives, in HLA-B27 negatives, in patients with concurrent methotrexate treatment and in patients not receiving biologic therapy (p > 0.05). Only two patients (1.5%, 95% CI - 0.6 to 3.5) developed cutaneous hypopigmentation and subcutaneous atrophy as side effects of injection.
Intra-articular corticosteroid injection was more effective especially in patients with low initial CRP levels and younger than 7 years of age. The duration of remission was longer in these patients. Key Points • Intra-articular corticosteroid injection is an effective method for controlling joint inflammation and achieving long-term remission without significant side effects. • Intra-articular corticosteroid injection can be preferred in all forms of juvenile idiopathic arthritis as primary therapy or to relieve the patient while waiting for the effect of systemic agents or to avoid increasing the dose of systemic drugs. • It can be recommended as a treatment option at any stage of the disease, especially in young patients and patients with low initial CRP values.
关节内皮质类固醇注射（IACI）通常用于治疗幼年特发性关节炎（JIA），以快速缓解活动性滑膜炎和功能恢复，并预防需要常规全身治疗。本研究旨在探讨 IACI 治疗的结果以及与滑膜炎缓解相关的因素。
回顾 2014 年 1 月至 2020 年 12 月期间在两家儿科风湿病中心接受 IACI 的 JIA 患者的临床记录。根据疗效、可能影响缓解持续时间的因素、程序和药物相关并发症评估该程序。
在研究期间，134 名患者接受了 227 次注射，37 个关节接受了多次注射。106 名（79%）患者患有持续性少关节炎疾病。在注射时，所有患者均接受非甾体抗炎药治疗，74 名患者接受甲氨蝶呤治疗，14 名患者接受生物制剂治疗。IACI 治疗后无滑膜炎加重的缓解持续时间中位数为 15（范围 1-64）个月。注射后 6 个月的无活动率为 81%。结果表明，发病时年龄小于 7 岁和初始 CRP 水平较低与缓解期较长相关（p<0.05）。尽管差异无统计学意义，但男孩、ANA 阳性、HLA-B27 阴性、同时接受甲氨蝶呤治疗和未接受生物治疗的患者缓解期较长（p>0.05）。只有 2 名患者（1.5%，95%CI-0.6 至 3.5）出现注射副作用，如皮肤色素减退和皮下萎缩。
关节内皮质类固醇注射在 CRP 水平较低和年龄小于 7 岁的患者中更为有效。这些患者的缓解期较长。关键点：•关节内皮质类固醇注射是控制关节炎症和实现长期缓解的有效方法，没有明显的副作用。•关节内皮质类固醇注射可作为幼年特发性关节炎的各种形式的主要治疗方法，也可在等待全身药物效果或避免增加全身药物剂量时缓解患者。•它可以在疾病的任何阶段推荐作为一种治疗选择，特别是在年轻患者和初始 CRP 值较低的患者中。
