Prevention of leg length discrepancy in young children with pauciarticularjuvenile rheumatoid arthritis by treatment with intraarticular steroids

Objective. To determine if intraarticular (IA) injection of triamcinolone h exacetonide (steroids) used early in the course of pauciarticular juvenile rheumatoid arthritis (pauci JRA) is associated with less leg length discrep ancy (LLD) or thigh circumference discrepancy (TCD), Methods. Children with pauci JRA who had asymmetric lower-extremity arthrit is diagnosed before age 7 years in Seattle, Washington (WA; n = 16) and in Chapel Hill and Durham, North Carolina (NC; n = 13) were retrospectively id entified. WA children were given LA steroids within 2 months of diagnosis; the injections were repeated if synovitis recurred in the same joint or in a different joint. These children were compared with NC children who were n ot treated with LA steroids. Thigh circumference was measured at 10 cm abov e the patella, and leg length was measured from the anterior superior iliac spine to the mid-medial malleolus, by a single observer, LLD and TCD are r eported as the percentage of difference between leg measurements in each su bject. Results, The WA and NC subjects had comparable disease severity and duratio n of followup (in months). Twelve WA children had subsequent LA steroid inj ections (mean 3.25 injections per child over mean a SD 42 +/- 11 months). T he WA subjects had significantly less LLD (P = 0.005, by Student's 2-sided t-test) and prescriptions for shoe lifts (P = 0.002, by Fisher's 2-sided ex act test). There was not a significant difference in TCD between the 2 grou ps (P = 0.139, by Student's 2-sided t-test). Similar findings were obtained when the analysis was limited to children with monarticular knee arthritis . Conclusion. Early and continued use of IA steroids may be associated with l ess LLD in young children with pauci JRA, This may indicate decreased durat ion of synovitis.