The efficacy and safety of intraarticular corticosteroid therapy for coxitis in juvenile rheumatoid arthritis

Neidel, J.; Boehnke, Martina; Küster, R. M.

doi:10.1002/art.10313

Cited by 68 publications

(27 citation statements)

References 26 publications

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“…The potential role of GC injection in the hip in causing avascular necrosis of the femoral head is unclear. Reported studies suggest that the risk is small and is probably increased by the simultaneous administration of systemic GCs [21,22]. …”

Section: Intra-articular Gcsmentioning

confidence: 99%

Glucocorticoids in Juvenile Idiopathic Arthritis

Schiappapietra

Varnier

Rosina

et al. 2014

Neuroimmunomodulation

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Glucocorticoid (GC) drugs are a potent and rapidly effective therapeutic option for the treatment of juvenile idiopathic arthritis (JIA). These medications are mainly used for the management of the extra-articular features of systemic-onset disease. A course of low-dose prednisone may be considered for achieving a rapid disease control in patients with severe polyarthritis refractory to other therapies or while awaiting the full therapeutic effect of a recently initiated disease-modifying antirheumatic drug or biologic agent. Short-term systemic GC administration may also be indicated for chronic iridocyclitis unresponsive to topical therapy. The general objective of GC therapy is to limit the maximum dose and exposure to the highest doses to what is needed to achieve disease control, and then to gradually taper the dose until the minimum level sufficient to maintain disease quiescence over time is reached. High-dose intravenous ‘pulse' methylprednisolone administration is sometimes chosen to treat the most severe or acute disease manifestations of systemic JIA, particularly macrophage activation syndrome. Intra-articular GC injection is a safe and rapidly effective treatment for synovitis in children with chronic arthritis. Triamcinolone hexacetonide is the optimal GC preparation for pediatric patients. Local injection therapy is used most frequently to treat oligoarthritis, but the strategy of performing multiple injections to induce disease remission, while simultaneously initiating therapy with second-line or biologic agents, has also been proposed for children with polyarticular JIA. Administration of GCs is associated with potentially deleterious adverse effects, some of which can be irreversible. This highlights the need of a judicious use of these medications and careful monitoring of their toxicity. The recently published recommendations for the management of JIA provide useful guidance to the clinicians for the administration of GCs in children with chronic arthritis.

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Section: Intra-articular Gcsmentioning

confidence: 99%

Glucocorticoids in Juvenile Idiopathic Arthritis

Schiappapietra

Varnier

Rosina

et al. 2014

Neuroimmunomodulation

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“…Important side effects of corticosteroids are listed in Table 3. Corticosteroids can be administered systemically (orally or parenterally) or locally [3].…”

Section: Corticosteroidsmentioning

confidence: 99%

“…If hygienic standards are followed, the risk of infection is low [5]. Aseptic bone necrosis, especially of the femoral head, is associated with systemic corticosteroids but not with intra-articular corticosteroids injected into the hip [3].…”

Section: Intra-articular Injections With Corticosteroidsmentioning

confidence: 99%

Treatment strategies for juvenile idiopathic arthritis

Klein

Horneff²

2009

Expert Opinion on Pharmacotherapy

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With this information, the reader receives an overview on the current available treatment options and will be enabled to guide modern treatment of the several JIA subgroups. Take home messages: Current treatment strategies in juvenile idiopathic arthritis (JIA) - including conventional and new therapeutics, biologics - have changed the outcome of JIA. Treatment with TNF inhibitors lead to a rapid and sustained suppression of inflammation and can effectively be used for treatment of polyarticular JIA. Blockers to further pro-inflammatory cytokines, IL-1 and IL-6 are most valuable for treatment of systemic-onset JIA. Blockers of T-cell activation are an alternative approach, slowly acting but targeting to complete inactivation of the disease. Future concepts for the post-biologics era of treatment of rheumatic diseases use antigen-specific tolerance induction and modulation of the immune response. Clinical remission has now become a reachable target in the treatment of JIA.

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“…(23) Another study reported three incidents of femoral head necrosis out of 67 IAG injections. However, these cases were found exclusively in the context of concurrent systemic corticosteroids, (24) thereby making it difficult to strictly determine IAG as the cause of femoral head AVN.…”

Section: Introductionmentioning

confidence: 99%