A subgroup-specific evaluation of the efficacy of intraarticular triamcinolone hexacetonide in juvenile chronic arthritis

Objective. To determine the subgroup-specific differences of intraarticular triamcinolone hexacetonide (TH) in the treatment of joint inflammation in patients with juvenile chronic arthritis (JCA). Methods. A retrospective review of 194 children of all subgroups of JCA, tr eated by a single or repeated TH injection between 1989 to 1994. Efficacy a nd duration of benefit were evaluated after a mean duration of 3, 15, 30, a nd 64 weeks. Results. In all, 1439 TH injections were given to 194 patients; 368 of thes e were reinjections. The median duration of improvement of all injections w as 74 weeks. Responses were significantly different among subgroups (p = 0. 0001): there were 121 weeks of efficacy in early-onset pauciarticular JCA t ype I (223 injections), 47 weeks: in late-onset pauciarticular JCA type II (190 injections), 105 weeks in rheumatoid factor negative polyarticular JCA (445 injections), 63 weeks in rheumatoid factor positive polyarticular JCA (127 injections), and 36 weeks in systemic JCA (413 injections). Forty-one injections were done in other rheumatic diseases. In relation to this resu lt there were also differences with regard to joint groups, antinuclear ant ibody (ANA) and HLA-B27 status, and sex, Side effects were rare: infections of skin or joints were not noted; skin and lipoatrophy were seen after 15 injections, necrosis of the hip in one case, luxation of 2 shoulders of one patient, and periarticular calcification in 3 patients. Conclusion. Intraarticular TH is an effective therapy for inflammatory join t disease in all subgroups of JCA. The risk of major complications is low. The median duration of improvement depends on the subgroup of the disease.