Application of Intra-articular Corticosteroid Injection in Juvenile Idiopathic Arthritis

Abstract

Juvenile idiopathic arthritis (JIA) is one of the common rheumatic diseases in pediatrics. Persistent synovitis and joint pain cause reduced range of motion, deformity and gait interruption, which are important reasons for children's disability and a decline in their quality of life. Rheumatology experts have explored good treatment strategies, among which intra-articular corticosteroid injections (IACIs) targeting joints can greatly reduce these systemic adverse reactions while still obtaining local anti-inflammatory effects. Local inhibition of synovitis by the use of steroid hormones in a joint cavity can avoid or reduce adverse reactions of systemic therapy, prevent or treat leg length variance and joint contracture, solve Baker's cyst, improve tenosynovitis, promote physical therapy and rehabilitation, make gait change smoothly, relieve pain, and restore joint function. Given the importance of IACIs in treating JIA, this paper reviewed the case selection, drug injection, dose selection, current anesthesia and injection techniques, the efficacy, recurrence, and influencing factors of IACIs, the management of physiotherapy intervention post-injection, the application of ultrasound guidance and the safety and complications of IACIs in children with JIA. This study aims to guide the use of IACIs for the best approach throughout the review.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

“…There is also no indication of which joint is involved or which steroid dose and preparation were used for injections. Prior studies have shown variability in joint specific response to IAS with knees and wrists responding better than ankles and midfoot joints [ 18 , 22 ]. Unfortunately, due to the lack of consistent availability of triamcinolone hexacetonide in the past decade, it is likely that some patients in this cohort received injections with the shorter-acting triamcinolone acetonide, potentially introducing bias into the results.…”

Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists

“…Systemic therapy usually starts with nonsteroidal anti‐inflammatory drugs (NSAIDs) followed by disease‐modifying anti‐rheumatic drugs (DMARDs, most often methotrexate) and biological drugs such as anti‐TNFα agents, as indicated. In other joints than the TMJ, intra‐articular corticosteroid injections are often used as an effective and safe treatment 48 . However, recent literature does not support the routine use of intra‐articular corticosteroid injection in the TMJs in growing patients, even if some effects are present 49,50 …”