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Durability of response to intra-articular corticosteroid injections with triamcinolone hexacetonide in juvenile idiopathic arthritis
© Srinivasan et al; licensee BioMed Central Ltd. 2012
Published: 13 July 2012
Intra-articular corticosteroid injection (IACI) with triamcinolone hexacetonide (TH) is a mainstay of therapy for patients with juvenile idiopathic arthritis (JIA). Our aim was to determine factors that affected the durability of response to IACI with TH in patients with JIA.
A retrospective chart review was conducted of all JIA patients who received IACI from 6/05 to 3/10, and had at least six months of follow-up. Data collected included demographic information, JIA subtype, date of injection and arthritis flare, type of joint injected and concomitant medications. Any joint that did not flare by the study end date in 9/10 was censored. Time to flare of arthritis was calculated based on the Kaplan-Meier product limit estimator. Two-sided log-rank test was conducted to compare the time to flare within each characteristic group: joints, diagnosis, medications. All analysis in this study was performed using SAS 9.2 (SAS Institute Inc, Cary, NC).
Factors affecting flare in JIA patients post-ICAI (n=184)
Time to flare median (days)
Extended oligoarthritis (n=23)
Systemic arthritis (n=14)
Enthesits-related arthritis (n=6)
Psoriatic arthritis (n=2)
Repeat IACI in JIA patients with arthritis flare
Flare afer second IACI n(%)
Flare after third IACI n(%)
IACI is an effective therapy for patients with JIA with the majority of patients having complete and long-lasting response to IACI. Over half of the injected joints did not relapse after a mean and median follow up of 23.7 months and 18.2 months, respectively. There was a significant difference in median time to flare between the elbow and wrist joints. Knees had the longest median time to relapse and hips the shortest; however, a larger sample is needed to determine if these represent significant differences. Systemic arthritis showed the shortest time to relapse, and was statistically different from oligoarthritis and polyarthritis. Concomitant medications did not have a significant effect on flare times. A larger study population is needed to better evaluate the effect of joint type and other factors on risk of recurrent flares.
Jaya Srinivasan: None; Themba L. Nyirenda: None; Kathleen A. Haines: None; Yukiko Kimura: None; Suzanne C. Li: None; Jennifer E. Weiss: None.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.