Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response

Cunha, Ana Luiza Garcia; Silva, Vanessa Bugni Miotto e; Osaku, Fabiane Mitie; Niemxeski, Luísa Brasil; Furtado, Rita Nely Vilar; Natour, Jamil; Terreri, Maria Teresa

doi:10.1016/j.rbre.2016.01.001

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…This is particularly pertinent given the often‐delayed onset of psoriatic features in children previously classified as oligo or polyarticular JIA 36 . That younger age of disease onset is generally associated with better outcomes, in terms of disease activity including treatment response, 37–39 is readily corroborated. However, the association is not as clear after adjustment for ILAR category, because those with oligoarthritis tend to both be younger and have milder disease 40 .…”

Section: Discussionmentioning

confidence: 98%

Overlap of International League of Associations for Rheumatology and Preliminary Pediatric Rheumatology International Trials Organization Classification Criteria for Nonsystemic Juvenile Idiopathic Arthritis in an Established UK Multicentre Inception Cohort

Shoop‐Worrall,

Macintyre,

Ciurtin

et al. 2024

Arthritis Care & Research

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ObjectivesTo assess the degree of overlap between existing International League of Associations for Rheumatology (ILAR) and preliminary Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria for JIA.MethodsParticipants from the Childhood Arthritis Prospective Study, a multicentre UK JIA inception cohort, were classified using the PRINTO and ILAR classification criteria into distinct categories. Systemic JIA was excluded as several classification items were not collected in this cohort. Adaptations to PRINTO criteria were required to apply to a UK healthcare setting, including limiting the number of blood biomarker tests required. The overlap between categories under the two systems was determined and any differences in characteristics between groups described.ResultsA total of 1,223 children and young people with a physician's diagnosis of JIA were included. Using PRINTO criteria, the majority of children had “Other JIA” (69.5%). There was a high degree of overlap (91%) between the PRINTO enthesitis/spondylitis‐ and ILAR enthesitis‐related JIA categories. The PRINTO RF‐positive category was composed of 48% ILAR RF‐positive polyarthritis and 52% undifferentiated JIA. The early‐onset ANA‐positive PRINTO category was largely composed of ILAR oligoarthritis (50%), RF‐negative polyarthritis (24%) and undifferentiated JIA (23%). Few children were unclassified under PRINTO (n=3) and would previously have been classified as enthesitis‐related JIA (n=1) and undifferentiated JIA (n=2) under ILAR.ConclusionUnder the preliminary PRINTO classification criteria for childhood arthritis, most children are not yet classified into a named category. These data can help support further delineation of the PRINTO criteria to ensure homogenous groups of children can be identified.

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Section: Discussionmentioning

confidence: 98%

Overlap of International League of Associations for Rheumatology and Preliminary Pediatric Rheumatology International Trials Organization Classification Criteria for Nonsystemic Juvenile Idiopathic Arthritis in an Established UK Multicentre Inception Cohort

Shoop‐Worrall,

Macintyre,

Ciurtin

et al. 2024

Arthritis Care & Research

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“…Studies have shown that more than half of the joints showed a good response to IACIs, and those with uveitis responded well to IACIs during the disease. Knees, wrists, and elbows were the most effective joints for IACIs ( 45 ).…”

Section: Methodsmentioning

confidence: 99%

Application of Intra-articular Corticosteroid Injection in Juvenile Idiopathic Arthritis

Zhang

Yang

2022

Front. Pediatr.

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Juvenile idiopathic arthritis (JIA) is one of the common rheumatic diseases in pediatrics. Persistent synovitis and joint pain cause reduced range of motion, deformity and gait interruption, which are important reasons for children's disability and a decline in their quality of life. Rheumatology experts have explored good treatment strategies, among which intra-articular corticosteroid injections (IACIs) targeting joints can greatly reduce these systemic adverse reactions while still obtaining local anti-inflammatory effects. Local inhibition of synovitis by the use of steroid hormones in a joint cavity can avoid or reduce adverse reactions of systemic therapy, prevent or treat leg length variance and joint contracture, solve Baker's cyst, improve tenosynovitis, promote physical therapy and rehabilitation, make gait change smoothly, relieve pain, and restore joint function. Given the importance of IACIs in treating JIA, this paper reviewed the case selection, drug injection, dose selection, current anesthesia and injection techniques, the efficacy, recurrence, and influencing factors of IACIs, the management of physiotherapy intervention post-injection, the application of ultrasound guidance and the safety and complications of IACIs in children with JIA. This study aims to guide the use of IACIs for the best approach throughout the review.

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“…IACIs appeared to be a safe and effective treatment option for the management of JIA, particularly the management of oligoarticular JIA. 40,41 IACIs are an effective way to control disease activity and to induce resolution of synovitis, decrease the presence of joint and limb deformities, improve function, provide pain relief and serve as A systematic review to evaluate the advantages of administering CSs during arthrocentesis for temporomandibular disorders, including JIA, found no significant differences in the clinical outcomes observed between the CS injection group and the control groups (which were injected with normal saline, physiological salt water or Ringer's lactate). 43 Ravelli et al 44…”

Section: Intra-articular Corticosteroidsmentioning

confidence: 99%

Different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis: the SIRJIA mixed-methods feasibility study

Jones

Clayton

Nkhoma

et al. 2020

Health Technol Assess

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Background In the UK, juvenile idiopathic arthritis is the most common inflammatory disorder in childhood, affecting 10 : 100,000 children and young people aged < 16 years each year, with a population prevalence of around 1 : 1000. Corticosteroids are commonly used to treat juvenile idiopathic arthritis; however, there is currently a lack of consensus as to which corticosteroid induction regimen should be used with various disease subtypes and severities of juvenile idiopathic arthritis. Objective The main study objective was to determine the feasibility of conducting a randomised controlled trial to compare the different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis. Design This was a mixed-methods study. Work packages included a literature review; qualitative interviews with children and young people with juvenile idiopathic arthritis and their families; a questionnaire survey and screening log to establish current UK practice; a consensus meeting with health-care professionals, children and young people with juvenile idiopathic arthritis, and their families to establish the primary outcome; a feasibility study to pilot data capture and to collect data for future sample size calculations; and a final consensus meeting to establish the final protocol. Setting The setting was rheumatology clinics across the UK. Participants Children, young people and their families who attended clinics and health-care professionals took part in this mixed-methods study. Interventions This study observed methods of prescribing corticosteroids across the UK. Main outcome measures The main study outcomes were the acceptability of a future trial for children, young people, their families and health-care professionals, and the feasibility of delivering such a trial. Results Qualitative interviews identified differences in the views of children, young people and their families on a randomised controlled trial and potential barriers to recruitment. A total of 297 participants were screened from 13 centres in just less than 6 months. In practice, all routes of corticosteroid administration were used, and in all subtypes of juvenile idiopathic arthritis. Intra-articular corticosteroid injection was the most common treatment. The questionnaire surveys showed the varying clinical practice across the UK, but established intra-articular corticosteroids as the treatment control for a future trial. The primary outcome of choice for children, young people, their families and health-care professionals was the Juvenile Arthritis Disease Activity Score, 71-joint count. However, results from the feasibility study showed that, owing to missing blood test data, the clinical Juvenile Arthritis Disease Activity Score should be used. The Juvenile Arthritis Disease Activity Score, 71-joint count, and the clinical Juvenile Arthritis Disease Activity Score are composite disease activity scoring systems for juvenile arthritis. Two final trial protocols were established for a future randomised controlled trial. Limitations Fewer clinics were included in this feasibility study than originally planned, limiting the ability to draw strong conclusions about these units to take part in future research. Conclusions A definitive randomised controlled trial is likely to be feasible based on the findings from this study; however, important recommendations should be taken into account when planning such a trial. Future work This mixed-methods study has laid down the foundations to develop the evidence base in this area and conducting a randomised control trial to compare different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis is likely to be feasible. Study registration Current Controlled Trials ISRCTN16649996. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 36. See the NIHR Journals Library website for further project information.

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Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response

Abstract: In our study, more than half of the joints showed a good response to IIC. Younger patients at diagnosis and uveitis during the course of the disease had good response to IIC. Knees, wrists and elbows were the joints that best responded to IIC. IIC proved to be a safe procedure.

Cited by 9 publications

References 18 publications

Overlap of International League of Associations for Rheumatology and Preliminary Pediatric Rheumatology International Trials Organization Classification Criteria for Nonsystemic Juvenile Idiopathic Arthritis in an Established UK Multicentre Inception Cohort

Overlap of International League of Associations for Rheumatology and Preliminary Pediatric Rheumatology International Trials Organization Classification Criteria for Nonsystemic Juvenile Idiopathic Arthritis in an Established UK Multicentre Inception Cohort

Application of Intra-articular Corticosteroid Injection in Juvenile Idiopathic Arthritis

Different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis: the SIRJIA mixed-methods feasibility study

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