INTRAARTICULAR CORTICOSTEROID INJECTION IN THE MANAGEMENT OF CHILDRENWITH CHRONIC ARTHRITIS

Objective: Intraarticular (IA) corticosteroid injection is a common th erapeutic approach in the management of adult rheumatoid arthritis. Th is study examined the safety and efficacy of IA corticosteroid injecti on in 71 patients with juvenile arthritis who were being seen at the S heba Medical Center during the years 1991-1996. Methods: Sixty-one pat ients fulfilled the American College of Rheumatology revised criteria for the diagnosis of juvenile rheumatoid arthritis (JRA), 6 patients h ad reactive arthritis, and 4 patients had various other arthritic cond itions. The mean ±SD age was 9.4 ±5.6 years (range 1.5-1 8 years); 47 were female (mean age 8.1 ±5.5 years) and 24 were male (mean age 10.8 ±5.4 years). A total of 300 joints were inj ected with tramincinolone hexacetonide. The common sites of injection were the knees (124 injections), ankles (71 injections), wrists (46 in jections), shoulders (10 injections), and elbows (7 injections). Child ren under the age of 6 (n=17), or older children who received more tha n 4 joint injections at one time (n=10) were sedated with either ketmi ne HCI or propofol. All other children received their joint injections under local anesthesia. Results: Full remission of the joint nflammat ion lastning >6 months following injection was achieved in 246 of the 300 injections (82.0%). In 54 (18.0%) of the injected joints, the infl ammation recurred within 6 months of injection. In patients with pauci articular arthritis, 115 of 141 injections (81.6%) resulted in full re mission. Discontinuation of all oral medications was accomplished in 4 3 patients (60.6%) of the total group of 71 patients and in 32 of the 43 patients with pauciarticular disease (74.4%). Correction of joint c ontraction was achieved in 42 children (55 joints). In all 11 patients with Baker's cyst and in 12 patients with tenosynovitis, complete rem ission was achieved following injection. No infection or other serious complications occurred in any of the patients following the procedure . Conclusion: IA corticosteroid joint injection in children with juven ile arthritis is a safe and effective mode of therapy. It may be the o nly therapy needed in patients with pauciarticular JRA, obviating the need for prolonged oral medications, and is effective in correcting jo int contractions and deformities.