|
Balogh et al, [30]
|
RCT
|
Fulfilment of EULAR/WHO Oslo Criteria for JCA.
|
23/23 (23 knees)
|
1, 3, 7 and 42 days
|
TH in 11/23
|
Knee Joint Circumference (cm); Knee Joint Flexion (degrees).
|
|
BM in 12/23
|
|
(Dose not recorded)
|
|
Pauciarticular form of disease.
|
Post-injection: Not specified.
|
|
Co-interventions: Not specified
|
|
Al-wahadneh, [31]
|
OBS
|
Failure to respond to NSAIDs with/without slow acting anti-inflammatories.
|
24/24 (30 knee joints)
|
3, 6, 9, 12 and 24 months.
|
MA 1 mg/kg/joint mixed with 1 cc 1% lidocaine without adrenaline.
|
Sustained Clinical Response: ‘Active Inflammation’ (joint effusion and heat and tenderness/pain with/without correction of deformity)
|
|
Co-interventions: 10/24: MTX (10 mg/kg/wk), 24/24: Naproxen (10-20 mg/kg/day), 24/24: NSAIDs, 11/24: Prednisolone (0.25 mg/kg/day)
|
Post-injection: Immobilisation 24 hrs post injection before commencing physiotherapy.
|
|
Allen et al., [32]
|
OBS
|
<16 yrs of age at onset of chronic arthritis 29/40 pauciarticular onset JRA
|
40/40 (53 knees) 4 patients lost to follow-up.
|
3, 6, 12 and 24 months.
|
20-40 mg TH with 1% xylocaine without epinephrine infiltration.
|
Sustained Clinical Response: ‘Active
|
|
4/40 seronegative enthesopathy-arthropathy syndrome
|
Post-injection: Not specified
|
Inflammation’(Joint effusion and heat and tenderness, with or without complete correction of deformity)
|
|
6/40 psoriatic arthritis
|
|
Co-interventions: 100%- acetylsalicylic acid for at least 3 months; 30%- 1 NSAID; 22.5%- 2 NSAIDs; 20%- ≥ 3 NSAIDs; 3 patients previously on oral prednisone; 1 patient on hydroxychloroquine; 4 patients prior corticosteroid injection (other than TH); all patients maintained on the same NSAIDs post-injection.
|
|
Beukelman et al., [26]
|
OBS
|
Definitive JIA diagnosis based on criteria.
|
38/38 (55 STJ injections)
|
1-30 weeks (median = 6 weeks)
|
TH in 13/38TA in 24/38
|
Sustained Clinical Response: STJ Eversion/Inversion and pain and gait abnormalities
|
|
Decreased foot inversion or eversion on physical examination
|
(Medication and dose not recorded in 1/39 injection)
|
|
Co-interventions: 14/38: MTX, 3/38: TNF-alpha inhibitor, 3/38: TNF-alpha inhibitor and MTX.
|
TA used when TH was commercially unavailable.
|
|
Post-injection: Non-weight bearing 24 hrs post-injection. Normal activity resumed afterwards.
|
|
Cahill et al., [25]
|
OBS
|
Clinical signs of STJ inflammation
|
38/38; 24/38
|
2-3 months
|
0.5-1 ml, 20 mg/ml TH
|
Increased STJ
|
|
Referral for image-guided IACI.
|
single STJ; 4/38 bilateral STJ; 3/38 subsequent contra-lateral STJ; 7/38 at least one repeated STJ.
|
(active disease) 6 months (without active disease)
|
Post-injection: Not specified.
|
inversion and eversion: Normal ROM, without pain and limping
|
|
Co-interventions: Not specified.
|
|
Earley et al., [33]
|
OBS
|
Pauci-articular onset JCA.
|
23/23 (86 knees)
|
3, 6 and 12 months
|
TH 20 mg for children weighing <20 kg (63 knees) OR for children >20 mg 40 mg (20 knees)
|
Sustained Clinical Response: Soft tissue swelling and joint effusion and degree of flexion contracture and degree of valgus deformity.
|
|
Painful swollen knee with poor function.
|
|
Not respondent to at least 3 months of conventional treatment.
|
|
Post-injection: Not specified.
|
|
Co-interventions: All patients were on at least one NSAID and physiotherapy and splinting, 3/23 on gold, 1/23 on prednisolone
|
|
Eberhard et al., [34]
|
OBS
|
JRA diagnosis based on ACR criteria.
|
85/85 (51/99 received TH and 48/99 received TA; 14 patients received both)
|
2 weeks then every 3 months for a minimum for 15 months.
|
TH: 40 mg (knee), 30 mg (ankle).
|
Sustained Clinical Response: Non-bony swelling and (if no swelling) limitation ROM pain on motion or joint tenderness.
|
|
Co-interventions: TH group: 33/51 NSAIDs; 16/51 MTX; 9/51 sulfasalzine; 3/51 prednisone + etanercept; 14/51 no medication.
|
|
TA: 80 mg (knee), 60 mg (ankles)
|
|
Post injection: Minimal activity for 24 hrs post-injection.
|
|
TA group: 33/51 NSAIDs; 12/51 MTX; 2/51 sulfasalazine; 4/51 etanercept; 2/51 prednisone; 2/51 leflunomide; 15/51 no medication.
|
|
Eich et al., [35]
|
OBS
|
JCA diagnosis based on EULAR criteria.
|
15/15 (11 knees)
|
Clinical and US assessment: 1 week and 1 month MRI: 1 month
|
TH: 40 mg (knee)
|
Pain
|
|
Post-injection: Not specified.
|
|
Failure of systemic therapy and physiotherapy.
|
Swelling
|
|
Hyperthermia
|
|
Local growth disturbances.
|
|
Limited ROM
|
|
Popliteal cyst in affected knee.
|
|
Leg-length discrepancy
|
|
With/without complete deformity correction.
|
|
MRI: Joint effusion
|
|
Co-interventions: Not specified.
|
|
Popliteal cyst
|
|
Destruction of articular cartilage and/or bone
|
|
Destruction of menisci
|
|
Marrow oedema
|
|
Avascular necrosis
|
|
US: Joint effusion and/or pannus
|
|
Popliteal cyst
|
|
Hertzberger-ten Cate et al., [36]
|
OBS
|
Type 1 pauciarticular JCA.
|
21/21 (27 knees)
|
6 months
|
TA: 20 mg in children weighing >20 kg with 1 ml lignocaine.
|
Sustained Clinical Response: swelling and synovial fluid and no increased temperature.
|
|
Chronic arthritis in ≥1 knee.
|
|
No response ≥6 months of conventional treatment.
|
|
Flexion contracture, muscle wasting and/or growth disturbances.
|
|
Co-interventions: 81% used splints at night and 1 hr during the day, 50% received physiotherapy, 77% received NSAIDs.
|
Post-injection: knee passively flexed and extended several times to distribute drug. No advice regarding activity levels.
|
|
Honkanen et al., [37]
|
OBS
|
JIA diagnosis.
|
79/79 (79 knees)
|
6-8 weeks
|
MA: in 45/79 (Mean dose 1.5 mg/kg)
|
Sustained Clinical Response: absence/presence of ‘symptoms’
|
|
With/without previous IACI.
|
|
Co-interventions: 100% on NSAID agents and regular physiotherapy, 17/79 on hydroxychloroquine, sodium aurothiomalate or auranofin (slow-acting antirheumatics), 5/79 on alternate day glucocorticoid therapy.
|
TH: in 34/79 (mean dose 0.7 mg/kg)
|
|
Post-injection: Non- weight bearing for 24 hrs.
|
|
Huppertz et al., [38]
|
OBS
|
Children with chronic arthritis, not responding to NSAIDs.
|
21/21(18 knees, 2 ankles)
|
7, 13 weeks
|
Knees: 1 mg/kg TH with 20 mg min dose and 60 mg maximum dose.
|
Joint Swelling
|
|
Co-interventions: Not pre-specified. After 13 weeks, 10/21 had been treated with concomitant NSAIDs and 5/21 received chloroquine.
|
Effusion
|
|
Ankle: “a lower dose”
|
|
Post injection: Not specified.
|
Joint limitation
|
|
Joint tenderness/pain
|
|
Laurell et al., [24]
|
OBS
|
JIA diagnosis based on ILR criteria.
|
30/30 (40 ankle regions)
|
4 weeks
|
TA 40 mg/ml
|
Pain
|
|
Post-injection: Not specified.
|
US: Synovial hypertrophy Synovial
|
|
Active disease.
|
|
Co-interventions: 26 patients had ongoing systemic treatment: 58% with MTX
|
hyperaemia
|
|
23% with MTX and biologics (3 etanercept, 2 adalimumab, 1 abatacept), 19% with systemic corticosteroids
|
Joint ROM
|
|
Lepore et al., [39]
|
OBS
|
JIA patients.
|
37/37 (87 injections of 37 knees)
|
7-65 months (average of 31.3 months)
|
TH: 1 mg/kg (maximum 40 mg)
|
Sustained Clinical Response: ‘Clinical signs of inflammation’
|
|
Failure to respond to 2 months NSAIDs.
|
|
Post-injection: Advised to keep child at home for first 24 hrs and to avoid physical exertion and carrying weights.
|
|
Relapse after full remission period.
|
|
Co-interventions: NSAID use was discontinued in all patients at time of local treatment
|
|
Marti et al., [19]
|
OBS
|
JIA patients who received injections and follow up as in patients.
|
60/60 (108 knees; 29 ankles, 5 STJ and 3 midfoot)
|
Knee: 1-69 months, Ankle: 1-39 months, STJ: 13 months, Midfoot: 0-3months. Digits: 18-66 months
|
TH: 40 mg (knee, shoulder and hips); 20 mg (wrist, elbow, ankle and STJ); 5 mg (finger and toes)
|
Sustained Clinical Response: Swelling and effusion and tenderness/pain
|
|
Co-interventions: Non-steroidal anti-rheumatic drugs, MTX, Systemic corticosteroids, Salazopyrine
|
|
TA: 80 mg (knee, shoulder and hips); 40 mg (wrist, elbow, ankle and STJ); 10 mg (finger and toes).
|
|
Children with a body weight 20-40 kg received 75% of these doses. Children with body weight <20 kg received 50% of these doses.
|
|
Post-injection: Advised to keep injected joint as quiet as possible for 24 hrs post-injection.
|
|
Papadopoulou et al., [40]
|
OBS
|
Diagnosis JIA based on ILR criteria.
|
220/220 (186 knees, 168 ankles, 67 STJ, 14 MTJ and 14 IPJ)
|
6 months
|
TH: 1 mg/kg (maximum 40 mg) in knee & hips; 0.75 mg/kg (maximum 30 mg) in ankles.
|
Synovitis
|
|
MA: 20-40 mg in STJ & intertarsal joints; 5-10 mg in smaller foot joints.
|
|
Post-injection: Avoid activity or weight bearing for 24 hrs post-injection.
|
|
Previous IACIs with minimum follow-up of 6 months.
| | | |
|
Co-interventions: 61.8% of patients received systemic medications including: MTX (56.8%),
| | | | |
|
Biologic agents (9.5%), Systemic corticosteroids (11.4%)
|
|
Ravelli et al., [41]
|
OBS
|
JIA diagnosis.
|
94/94 (66/94- unilateral knee 28/94 bilateral knees)
|
6 months
|
TH: 1 mg/kg (maximum 40 mg) with 0.5 ml lignocaine (2%).
|
Sustained Clinical Response: Synovitis
|
|
Initial injection between Feb 1996 and June 1990.
|
|
Co-interventions: 57% on NSAIDs, 24% on NSAIDs and “2nd line drugs” (no specification of second line drugs)
|
|
Post-injection: Rest joints for 24 hrs
|
|
Remedios et al., [42]
|
OBS
|
Children with JIA presenting as painful swollen ankles.
|
11/11 (13 ankles)
|
>64 weeks
|
TH: 20 mg with 1 ml 0.5% bupivacaine.
|
Sustained Clinical Response: Synovitis (clinically assessed)
|
|
Co-interventions: Not Specified
| | |
Post-injection: Not specified.
|
MRI: Pannus
|
|
Sherry et al., [43]
|
OBS
|
Pauciarticular JCA from ACR criteria.
|
16/16 (15 knees and 6 ankles)
|
Mean follow-up University of Washington group: 42 months (SD +/- 11).
|
University of Washington Group: 20 mg TH within 2 months of diagnosis.
|
Leg Length Discrepancy (cm)
|
|
<7 years at diagnosis.
|
|
Reviewed at rheumatology centres at University of Washington or North Carolina (University of North Carolina/Duke University)
|
| |
North Carolina group: 46 months (SD +/- 15)
|
North Carolina Group: No IACI.
|
Thigh circumference discrepancy (cm)
|
|
Co-interventions: University of Washington Group: 25% on DMARD therapy, 44% with physical therapy evaluation, 31% with splints, 0% with shoe lifts North Carolina Group: 21% on DMARD therapy, 57% with physical therapy evaluation, 43% with splints, 50% with shoe lifts
| | |
Post-injection: Not specified.
|
|
Sornay-Soares et al., [44]
|
OBS
|
Children meeting the 1997 Durban criteria for JIA with knee involvement.
|
8/8 (13 knees)
|
6 months, 12 months
|
Joint lavage using 2 needles and 0.5-1.51 ml saline. Followed by one vial of TH, except in 2 knees (one patient) BM was used.
|
Sustained Clinical Response: Pain and joint effusion
|
|
Co-interventions: 6/8 on NSAIDs, 5/8 on MTX, 1/8 on Azathioprine, 2/8 on Cyclosporine
|
|
Post-injection: Knees were taped and advised to rest for 24 hrs, keeping in extension with walking crutches. Ice packs could be used for pain relief.
|
|
Verma et al., [45]
|
OBS
|
Diagnosis of unresponsive oligoarticular/polyarticular JIA.
|
13/13 (13 knees and 3 ankles) 3 patients were lost to follow-up at 6 months due to uncontrolled arthritis.
|
6, 12 weeks.
|
TA (0.5-1 ml, 20-40 mg).
|
Mid-leg circumference (cm)
|
|
Joint swelling/effusion, limitation of ROM, tenderness, pain, warmth.
|
4 children were lost to follow-up at 12 months.
| |
Post-injection: Reduced movement for 24 hrs.
|
|
12 weeks daily oral naproxen and/or weekly MTX.
|
|
Co-interventions: All patients were on NSAIDs.
|
|
Zulian et al., [46]
|
OBS
|
Diagnosis persistent or extended oligoarticular JIA
|
85/85 (115 knees and 15 ankles)
|
1, 3, 6, 9, 12, 18 and 24 months
|
TH: 42 patients treated; 1 mg/kg (>40 mg)
|
Sustained Clinical Response: Swelling and limited ROM and pain and warmth.
|
|
Patients managed at University of Padua paediatric rheumatology unit
|
TA:43 patients treated; 1 mg/kg (>40 mg) (Availability issues of TH meant TA was used as an alternative in some cases).
|
|
Received IACIs from Jan 1996 and Dec 2000.
|
|
Unsatisfactory response to NSAIDs.
|
|
Persistent isolated joint involvement.
|
Post-injection: Non-weight bearing for
|
|
Co-interventions: TH: 64.3% on NSAIDs, 11.4% on MTX
|
at last 72 hrs post-injection.
|
| | |
TA:51.7% on NSAIDs, 5% on MTX
| | | |
