Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections.

Postgraduate medicine Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI:10.1080/00325481.2024.2412969
Çisem Yıldız, Batuhan Küçükali, Merve Kutlar, Nuran Belder, Nihal Karaçayır, Pelin Esmeray Şenol, Emine Nur Sunar Yayla, Deniz Gezgin Yildirim, Sevcan A Bakkaloğlu
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Abstract

Background: Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI).

Methods: In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy.

Results: Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile.

Conclusions: Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

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幼年特发性关节炎的治疗:对使用关节内皮质类固醇注射的见解。
背景:幼年特发性关节炎(JIA)是儿童常见的慢性风湿病,需要精心治疗以降低短期和长期发病率。在这项研究中,我们的目的是评估确诊为 JIA 并接受了关节内皮质类固醇注射(IACI)的患者的临床特征:在这项回顾性研究中,我们评估了从 2012 年 1 月至 2023 年 10 月在一家三级医疗中心接受监测的 225 名 JIA 患者的临床和实验室特征。我们关注的重点是接受关节内皮质类固醇注射(IACI)治疗的患者。由于曲安奈德(TH)的安全性和有效性已得到证实,因此我们使用了曲安奈德:我们的分析表明,IACI,尤其是使用TH,是一种广泛使用且有效的辅助疗法,有助于快速缓解症状和控制局部疾病。接受 IACI 治疗的患者症状出现较早、确诊年龄较小、随访时间较长、累积治疗负担较重(P P P P P P 结论):值得注意的是,关节内皮质类固醇注射(IACI)在关节特异性基础上实现了高比例的关节炎缓解,这凸显了其疗效和良好的安全性。诊断时淋巴细胞计数超过 5000/mm3 可作为考虑关节内注射类固醇的早期指标。这些研究结果表明,JIA 的治疗需要细致入微的个体化治疗策略,以优化患儿的预后。
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