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Delineating the role of multiple intra-articular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era.
MedLine Citation:
PMID:  23335483     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE.: To investigate the outcome and predicting factors of multiple intra-articular corticosteroid (IAC) injections in children with juvenile idiopathic arthritis (JIA). METHODS.: The clinical charts of patients who received their first IAC injection in > 3 joints between January 2002 and December 2011 were reviewed. The corticosteroid used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. In each patient, the follow-up period after IAC injection was censored in case of synovitis flare or at last visit with continued remission. Predictors included sex, age at disease onset, JIA category, antinuclear antibody (ANA) status, age and disease duration, disease course, general anesthesia, number and type of injected joints, acute phase reactants, and concomitant systemic medications. RESULTS.: A total of 220 patients who had 1096 joints injected were included. Following IAC therapy, 66.4% of patients had synovitis flare after a median of 0.5 years, whereas 33.6% of patients had sustained remission after a median of 0.9 years. The cumulative probability of survival without synovitis flare was 50.0%, 31.5% and 19.5% at 1, 2 and 3 years, respectively. On Cox regression analysis, positive C-reactive protein, negative ANA, lack of concomitant methotrexate administration, and a polyarticular (versus an oligoarticular) disease course were the strongest predictors for synovitis flare. CONCLUSION.: Multiple IAC therapy induced sustained remission of joint synovitis in a substantial proportion of patients. A controlled trial comparing multiple IAC therapy and methotrexate versus methotrexate and a tumor necrosis factor antagonist is worthy of consideration. © 2013 by the American College of Rheumatology.
Authors:
Charalampia Papadopoulou; Mikhail Kostik; Maria Isabel Gonzalez-Fernandez; Marek Bohm; Juan Carlos Nieto-Gonzalez; Angela Pistorio; Stefano Lanni; Alessandro Consolaro; Alberto Martini; Angelo Ravelli
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-17
Journal Detail:
Title:  Arthritis care & research     Volume:  -     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
Affiliation:
Istituto Giannina Gaslini, Genova, Italy.
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