ROLE OF INTRA-ARTICULAR CORTICOSTEROID INJECTION IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Abstract

ABSTRACT:

OBJECTIVE: To determine the role of intra-articular corticosteroid injection (IACI) in inducing remission of synovitis in children with Juvenile idiopathic arthritis.

MATERIALS AND METHODS:  This quasi-experimental study was directed at the Pediatric Medicine/ Rheumatology Department at The University of Child Health Sciences Lahore from July 2021 to July 2022. All patients, regardless of gender, who met the JIA with synovitis criteria set forth by the International League of Associations for Rheumatology were enrolled and given IACIs (single or multiple). Data from pre- and post-IACI (after 6 months of IACI) were recorded, including synovitis symptoms and signs, erythrocyte sedimentation rate (ESR), and patients' and doctors' visual analogue pain scale (VAS). SPSS version 23 was used for the statistical analysis. For qualitative variables, frequency and percentages were computed. For the quantitative variables, a mean and standard deviation were computed. The post-IACI response for quantitative variables was ascertained using a paired sample t-test. A significant P-value was defined as < 0.05.

RESULTS: A total of 45 joints from 27 individuals were injected. There were 16/27 (60%) males and a 1.5:1 M:F ratio. At IACIs, the average age was 9.1 + 3.5 years. The most common joint implicated in 33/45 (73.3%) cases was the knee joint, which was followed in frequency by the wrist in 5/45 (11.1%), ankle in 4/45 (8.9%), and proximal interphalangeal joint in 3/45 (7%) cases.  Movement restriction was one of the indications of a synovitis flare, along with warmth, edema, and pain in 21 joints (46.7%). Three months following IACI, 34 joints (76%) had established remission. Regarding joint synovitis (p=0.005), ESR (p=0.005), VAS physicians (p=0.006), and VAS parents/patient (p=0.009), there was a statistically significant improvement after IACI.

CONCLUSION:

IACI is a type of local therapy used to treat juvenile idiopathic arthritis. They assist patients avoid systemic steroids and their harmful side effects by reversing joint synovitis and improving ESR and VAS (patient, parent, and physician).