Intra-articular corticosteroids in the treatment of juvenile idiopathic arthritis: Safety, efficacy, and features affecting outcome. A comprehensive review of the literature

Gotte, Alisa

doi:10.2147/oarrr.s5103

Cited by 22 publications

(14 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nowadays, intraarticular injection has been applied to the polyarticular subtype as bridging therapy until disease-modifying antirheumatic drugs (DMARDS) therapy starts working effectively, helping to resolve joint deformity and reducing pain. 9 In our study, females predominated with a female: male ratio of 1.6:1, similar to other studies which reported a predominance of females with JIA (ratios of 1:3 to 1:5, respectively). 6,10 Females might have greater risk for developing autoimmune diseases because of the two copies of the X chromosome and estrogen which plays a role as a promoting factor of the autoimmune processes.…”

Section: Discussionsupporting

confidence: 91%

Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy

Diwasasri

Sumadiono²,

Mulatsih³

2019

View full text Add to dashboard Cite

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. It can continue into adulthood and cause severe joint damage, resulting in disability and decreased quality of life. Objective To determine the predictors of clinical outcomes in JIA patients receiving intra-articular corticosteroid injections (IACS). Methods We conducted a retrospective cohort study of children with JIA receiving IACS therapy in Dr. Sardjito General Hospital from 1 January 2012 to 31 December 2017 by reviewing data from medical records. The dependent variables were disabilities and early remission time. Independent variables included age at diagnosis, JIA subtype, duration of disease at first diagnosis, timing of IACS, exposure to oral systemic therapy, as well as anti-nuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) test results. External variables were gender and nutritional status. Results Of 36 patients who received intraarticular corticosteroid injections, 28 (77.8%) experienced remission, and 16 (50%) experienced disabilities. Female subjects (OR 5.296; 95%CI 1.143 to 24.548; P=0.027) and subjects with ESR >26 mm/h (OR 2; 95%CI 1.259 to 3.170; P=0.043) were more likely to have disabilities. Use of oral corticosteroids for ≤3 months and IACS treatment ≤ 3 months after diagnosis were predictors of early remission time (OR 6.897; 95%CI 1.869 to 25 and OR 3.290; 95%CI 1.195 to 9.091, respectively). However, only oral corticosteroid had a significant correlation in multivariate analysis. Conclusion Female gender and ESR > 26 mm/h predict disabilities in JIA patients receiving IACS. Duration of oral corticosteroid ≤3 months and early IACS within 3 months of diagnosis correlate to earlier remission time. Shorter duration of oral corticosteroid is the only significant predictor for earlier remission time in JIA patients receiving IACS therapy.

show abstract

Section: Discussionsupporting

confidence: 91%

Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy

Diwasasri

Sumadiono²,

Mulatsih³

2019

View full text Add to dashboard Cite

show abstract

“…IACS are a mechanism of providing local and long-lasting effective therapy to patients, thus providing in many cases very rapid relief of symptoms and potentially sparing the requirement of systemic therapy among patients with persistent oligoarticular arthritis [ 7 ]. Among the IACS preparations, a randomized controlled trial (RCT) of children with bilateral knee arthritis revealed that triamcinolone hexacetonide resulted in longer-lasting remission compared to triamcinolone acetonide [ 8 ].…”

Section: Reviewmentioning

confidence: 99%

Treatment of juvenile idiopathic arthritis: a revolution in care

2014

View full text Add to dashboard Cite

A generation ago, children with arthritis faced a lifetime of pain and disability. Today, there are a multitude of treatment options, including a variety of biologics targeting key cytokines and other inflammatory mediators. While non-steroidal anti-inflammatory drugs and corticosteroids were once the mainstay of therapy, they are now largely used as bridge or adjunctive therapies. Among the conventional disease-modifying anti-rheumatic drugs, methotrexate remains first-line therapy for most children with juvenile idiopathic arthritis (JIA) due to its long track record of safety and effectiveness in the management of peripheral arthritis. Sulfasalazine and leflunomide may also have a secondary role. The tumor necrosis factor inhibitors (TNFi) have shown tremendous benefit in children with polyarticular JIA and likely in enthesitis-related arthritis and psoriatic JIA as well. There may be additional benefit in combining TNFi with methotrexate. Abatacept and tocilizumab also appear to benefit polyarticular JIA; the role of rituximab remains unclear. For the treatment of systemic JIA, while the TNFi are of less benefit, blockade of interleukin-1 or interleukin-6 is highly effective. Additionally, interleukin-1 blockade appears to be effective treatment of macrophage activation syndrome, one of the most dangerous complications of JIA; specifically, anakinra in combination with cyclosporine and corticosteroids may obviate the need for cytotoxic approaches. In contrast, methotrexate along with the TNFi and abatacept are effective agents for the management of uveitis, another complication of JIA. Overall, the biologics have demonstrated an impressive safety record in children with JIA, although children do need to be monitored for rare but potentially dangerous adverse events, such as tuberculosis and other infections; paradoxical development of additional autoimmune diseases; and possibly an increased risk of malignancy. Finally, there may be a window of opportunity during which children with JIA will demonstrate most optimal responses to aggressive therapy, underscoring the need for rapid diagnosis and initiation of treatment.

show abstract

“…Обсуждая оптимальные сроки наиболее эффективного применения изолированной локальной стероидной терапии, можно отметить, что «терапевтическое окно» строго ограничено 6-12 мес с момента дебюта заболевания. Последующие инъекции целесообразно проводить при условии отсутствия признаков прогрессирования суставного синдрома [24].…”

Section: Discussionunclassified

Retrospective analysis of the effectiveness of local corticosteroid therapy in children with oligoarticular juvenile idiopathic arthritis

et al. 2021

View full text Add to dashboard Cite

РЕЗЮМЕАктуальность. Несмотря на большой прогресс в диагностике и лечении ревматических заболеваний у детей, все еще остается актуальным вопрос выбора противовоспалительной терапии в случае дебюта хронического олигоартрита. Единого мнения на этот счет у детских ревматологов нет и по настоящий день.Цель. Поиск предикторов ранней неэффективности и оценка целесообразности локальной стероидной монотерапии у пациентов с дебютом олигоартикулярного варианта ювенильного артрита.Материалы и методы. Основу ретроспективного исследования составили 92 ребенка в возрасте от 11 мес до 9 лет с хроническим олигоартритом без экстраартикулярных проявлений (олиго-ЮА). Были изучены особенности клинико-инструментальной и лабораторной диагностики в дебюте заболевания, динамика суставного синдрома и эффективность внутрисуставного введения глюкокортикостероидного препарата.Результаты. Проанализированы данные 92 детей со 164 «активными» суставами, которые получили 218 изолированных внутрисуставных манипуляций по введению стероидного препарата (триамцинолон ацетонид). Триамцинолон ацетонид вводился внутрисуставно в дозе 20-40 мг с интервалом 3, 6, 12 мес в зависимости от активности заболевания. Около одной трети детей с олиго-ЮА достигли неактивной стадии болезни в среднем после двукратного введения данного препарата. Исследование не позволило выявить предикторов ранней неэффективности монотерапии локальными стероидными препаратами у детей. Не выявлено достоверных клинико-инструментальных и лабораторных признаков, которые напрямую указывали бы на необходимость начала ранней терапии препаратом «Метотрексат».Заключение. Триамцинолон ацетонид является эффективным и безопасным препаратом у детей с олигоартикулярным вариантом ювенильного артрита. Несмотря на популяризацию генно-инженерной биологической терапии, не следует пренебрегать лечением локальными стероидными препаратами как первой линией противоревматической терапии у детей. Ключевые слова: ювенильный артрит, хронический олигоартрит, триамцинолон ацетонид. Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи. Источник финансирования. Авторы заявляют об отсутствии финансирования при проведении исследования. Соответствие принципам этики. Все законные представители подписали добровольное информированное согласие на участие в исследовании. Исследование одобрено локальным этическим комитетом Науч-

show abstract

Intra-articular corticosteroids in the treatment of juvenile idiopathic arthritis: Safety, efficacy, and features affecting outcome. A comprehensive review of the literature

Cited by 22 publications

References 57 publications

Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy

Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy

Treatment of juvenile idiopathic arthritis: a revolution in care

Retrospective analysis of the effectiveness of local corticosteroid therapy in children with oligoarticular juvenile idiopathic arthritis

Contact Info

Product

Resources

About