The efficacy and safety of intra-articular injection of triamcinolone acetonide versus triamcinolone hexacetonide for treatment of juvenile idiopathic arthritis

Abstract

Objectives Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. Intra-articular corticosteroids joint injection (IAJI), with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA), is an effective additional treatment for oligo and polyarticular JIA. Previous studies have shown the benefits of TH over TA; however, TA is still used in many pediatric rheumatology centers. Our unit has experience with both regimens, and therefore we aimed to compare the efficacy and safety of TA versus TH for JIA patients. Methods Chart review of JIA patients who were randomly (based on drug availability) treated with TA or TH IAJI during 2010–2019. Primary outcomes for efficacy were defined as full recovery from arthritis one month after IAJI and a relapse rate of arthritis 3 months after IAJI. Primary outcome for safety was defined as the occurrence of adverse events (AEs) during the follow up period after IAJI. Results Overall, 292 joints of 102 JIA patients were treated (138 TA/154 TH joints). Complete recovery after one month was documented in 107 (69.6%) of TA treated joints and 96 (69.5%) of TH treated joints (P = 0.232). However, rate of relapse after 3 months was significantly higher for TA treated joints (27 (20.1%) vs. 13 (8.8%), respectively, P < 0.01). No AEs were documented except minor scars at four joint injection sites. Conclusion The recovery from arthritis was similar (~ 70%) with both regimens, however relapse rate was more than double in TA as compared to TH injected joints. These findings are important due to a contemporary shortage of TH in the US market.

Behandlung therapierefraktärer Verläufe der polyartikulären JIA

“…durch knöcherne Destruktionen instabile Verhältnisse können jedoch bei Befall dieser Gelenke operative Verfahren (HWS 61 , TMG 62 ) erforderlich machen. Bei insgesamt guter Entzündungskontrolle aber einzelnen aktiven Gelenken an den Extremitäten können zusätzlich zur fortgeführten systemischen Therapie intraartikuläre Steroidinjektionen 63 oder eine Synovektomie einen Beitrag zum Erreichen des Therapiezieles (inaktive Erkrankung) leisten 64 , 65 .…”

Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies

“…The two most frequently injected agents are triamcinolone hexacetonide and triamcinolone acetonide, and the former is strongly recommended by the American College of Rheumatology [14]. Remission is longer with triamcinolone hexacetonide than with triamcinolone acetonide, although the most recent results on this topic are contradictory [24][25][26][27][28]. The reported adverse events rates are low, and the most frequent reported adverse event is subcutaneous atrophy [23,29].…”

Patterns of clinical joint inflammation in juvenile idiopathic arthritis

“… 2 However, local relapses occur in up to 20% of joints within 3 months postinjection. 3 When systemic antirheumatic treatments are also used, minimal disease activity has been reported in 55% of patients with oligoarthritis after 2 years. 4 For children with polyarthritis systemic treatment, aimed at minimal or no disease activity, may be sufficient.…”

“…Currently, guidelines recommend to start treatment of oligoarthritic JIA with intraarticular glucocorticoids (with or without non-steroid anti-inflammatory drugs) 2. However, local relapses occur in up to 20% of joints within 3 months postinjection 3. When systemic antirheumatic treatments are also used, minimal disease activity has been reported in 55% of patients with oligoarthritis after 2 years 4.…”