Skip to main content

Advertisement

SpringerLink
Log in

What are the factors associated with the duration of remission of intra-articular corticosteroid injection in juvenile idiopathic arthritis?

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Petty RE, Southwood R, Manners P et al (2004) International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision. Edmonton, J Rheumatol 31:390–392

    Google Scholar 

  2. Beukelman T, Patkar NM, Saag KG et al (2011) American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 63(465–82):3

    Google Scholar 

  3. Scott C, Meiorin S, Filocamo G et al (2010) A reappraisal of intra-articular corticosteroid therapy in juvenile idiopathic arthritis. Clin Exp Rheumatol 28:774–781

    CAS  PubMed  Google Scholar 

  4. Bloom BJ, Alario AJ, Miller LC (2011) Intra-articular corticosteroid therapy for juvenile idiopathic arthritis: report of an experiential cohort and literature review. Rheumatol Int 31:749–756

    Article  CAS  PubMed  Google Scholar 

  5. Padeh S, Passwell JH (1998) Intraarticular corticosteroid injection in the management of children with chronic arthritis. Arthritis Rheum 41:1210–1214

    Article  CAS  PubMed  Google Scholar 

  6. Papadopoulou C, Kostik M, Gonzalez-Fernandez MI et al (2013) Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era. Arthritis Care Res (Hoboken) 65(7):1112–1120

    Article  CAS  Google Scholar 

  7. Huppertz HI, Tschammler A, Horwitz AE et al (1995) Intraarticular corticosteroids for chronic arthritis in children: efficacy and effects on cartilage and growth. J Pediatr 127:317–321

    Article  CAS  PubMed  Google Scholar 

  8. Gotte AC (2009) Intra-articular corticosteroids in the treatment of juvenile idiopathic arthritis: Safety, efficacy, and features affecting outcome. A comprehensive review of the literature. Open Access Rheumatol 14(1):37–49

    Article  Google Scholar 

  9. Consolaro A, Ruperto N, Bazso A et al (2009) Paediatric Rheumatology International Trials Organisation. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum 15;61(5):658–66

  10. Beukelman T, Guevara JP, Albert DA et al (2007) Variation in the initial treatment of knee monoarthritis in juvenile idiopathic arthritis: a survey of pediatric rheumatologists in the United States and Canada. J Rheumatol 34(9):1918–1924

    PubMed  Google Scholar 

  11. Cunha AL, Silva ME, VB, Osaku FM, et al (2016) Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response. Rev Bras Reumatol Engl Ed 56(6):490–496

    Article  PubMed  Google Scholar 

  12. Unsal E, Makay B (2008) Intraarticular triamcinolone in juvenile idiopathic arthritis. Indian Pediatr 45(12):995–997

    PubMed  Google Scholar 

  13. Marti P, Molinari L, Bolt IB et al (2008) Factors influencing the efficacy of intra-articular steroid injections in patients with juvenile idiopathic arthritis. Eur J Pediatr 167:425–430

    Article  PubMed  Google Scholar 

  14. Breit W, Frosch M, Meyer U et al (2000) A subgroup-specific evaluation of the efficacy of intraarticular triamcinolone in juvenile chronic arthritis. J Rheumatol 27(11):2696–2702

    CAS  PubMed  Google Scholar 

  15. Leow OM, Lim LK, Ooi PL et al (2014) Intra-articular glucocorticoid injections in patients with juvenile idiopathic arthritis in a Singapore hospital. Singapore Med J 55(5):248–252

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ravelli A, Manzoni SM, Viola S et al (2001) Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis. J Rheumatol 28(9):2100–2102

    CAS  PubMed  Google Scholar 

  17. Lanni S, Bertamino M, Consolaro A et al (2011) Outcome and predicting factors of single and multiple intra- articular corticosteroid injections in children with juvenile idiopathic arthritis. Rheumatology (Oxford) 50(9):1627–1634

    Article  CAS  Google Scholar 

  18. Lepore L, Del Santo M, Malorgio C et al (2002) Treatment of juvenile idiopathic arthritis with intra-articular triamcinolone hexacetonide: evaluation of clinical effectiveness correlated with circulating ANA and T gamma/delta + and B CD5+ lymphocyte populations of synovial fluid. Clin Exp Rheumatol 20(5):719–722

    CAS  PubMed  Google Scholar 

  19. Ravelli A, Davì S, Bracciolini G et al (2017) Intra-articular corticosteroids versus intra-articular corticosteroids plus methotrexate in oligoarticular juvenile idiopathic arthritis: a multicentre, prospective, randomised, open-label trial. Lancet 389(10072):909–916

    Article  CAS  PubMed  Google Scholar 

  20. Honkanen VE, Rautonen JK, Pelkonen PM (1993) Intra-articular glucocorticoids in early juvenile chronic arthritis. Acta Paediatr 82(12):1072–1074

    Article  CAS  PubMed  Google Scholar 

  21. Padeh S, Passwell JH (1998) Intraarticular corticosteroid injection in the management of children with chronic arthritis. Arthritis Rheum 41(7):1210–1214

    Article  CAS  PubMed  Google Scholar 

  22. Harhay R, Jeelani W, Agbor BTA, et al (2021) Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis. Pediatr Rheumatol Online J 20;19(1):36

  23. Taylor WJ, Fransen J, Dalbeth N et al (2016) Diagnostic arthrocentesis for suspicion of gout is safe and well tolerated. J Rheumatol 43(1):150–3

    Article  PubMed  Google Scholar 

  24. Job-Deslandre C, Menkes CJ (1990) Complications of intra-articular injections of triamcinolone hexacetonide in chronic arthritis in children. Clin Exp Rheumatol 8:413–416

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Rheumatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey

    Fatma Aydın, Nilgün Çakar, Zeynep Birsin Özçakar & Fatoş Yalçınkaya

  2. Division of Pediatric Rheumatology, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey

    Tuba Kurt, Banu Çelikel Acar & Elif Çelikel

Authors
  1. Fatma Aydın
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nilgün Çakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tuba Kurt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Banu Çelikel Acar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elif Çelikel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeynep Birsin Özçakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fatoş Yalçınkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fatma Aydın.

Ethics declarations

Disclosures

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aydın, F., Çakar, N., Kurt, T. et al. What are the factors associated with the duration of remission of intra-articular corticosteroid injection in juvenile idiopathic arthritis?. Clin Rheumatol 41, 3791–3796 (2022). https://doi.org/10.1007/s10067-022-06327-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-022-06327-4

Keywords

Search

Navigation