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Durability of response to intra-articular corticosteroid injections with triamcinolone hexacetonide in juvenile idiopathic arthritis
Srinivasan et al. Pediatric Rheumatology 2012, 10(Suppl 1):A47http://www.ped-rheum.com/content/10/S1/A47
Durability of response to intra-articularcorticosteroid injections with triamcinolonehexacetonide in juvenile idiopathic arthritis
Jaya Srinivasan2*, Themba L Nyirenda1, Kathleen A Haines1, Yukiko Kimura1, Suzanne C Li1, Jennifer E Weiss1
From 2011 Pediatric Rheumatology Symposium sponsored by the American College of RheumatologyMiami, FL, USA. 2-5 June 2011
ence in time to flare between elbow and wrist joints.
Intra-articular corticosteroid injection (IACI) with
Although hip joints showed the shortest time to flare,
triamcinolone hexacetonide (TH) is a mainstay of ther-
the sample size was too small to tell if the difference
apy for patients with juvenile idiopathic arthritis (JIA).
Our aim was to determine factors that affected the dur-
Twenty to 36% of each joint type received a second
ability of response to IACI with TH in patients with
IACI. About a third of the re-injected knee joints
required a third IACI, and all four of the re-injected hipjoints received a third IACI.
MethodsA retrospective chart review was conducted of all JIA
patients who received IACI from 6/05 to 3/10, and had
IACI is an effective therapy for patients with JIA with
at least six months of follow-up. Data collected included
the majority of patients having complete and long-last-
demographic information, JIA subtype, date of injection
ing response to IACI. Over half of the injected joints
and arthritis flare, type of joint injected and concomitant
did not relapse after a mean and median follow up of
medications. Any joint that did not flare by the study
23.7 months and 18.2 months, respectively. There was a
end date in 9/10 was censored. Time to flare of arthritis
significant difference in median time to flare between
was calculated based on the Kaplan-Meier product limit
the elbow and wrist joints. Knees had the longest med-
estimator. Two-sided log-rank test was conducted to
ian time to relapse and hips the shortest; however, a lar-
compare the time to flare within each characteristic
ger sample is needed to determine if these represent
group: joints, diagnosis, medications. All analysis in this
significant differences. Systemic arthritis showed the
study was performed using SAS 9.2 (SAS Institute Inc,
shortest time to relapse, and was statistically different
from oligoarthritis and polyarthritis. Concomitant medi-cations did not have a significant effect on flare times. A
larger study population is needed to better evaluate the
There were 112 patients (83 females) and 198 separate
effect of joint type and other factors on risk of recurrent
joints included in the study. Fourteen (7.1%) joints did
not respond to their first IACI. Of the 184 joints thatdid respond to the initial IACI, 99 (53.8%) fully
improved and did not relapse during the study period
Jaya Srinivasan: None; Themba L. Nyirenda: None;
(duration of follow-up: mean 723.7 ±421 days; median
Kathleen A. Haines: None; Yukiko Kimura: None;
553 days, IQR 385-994). There was a significant differ-
Suzanne C. Li: None; Jennifer E. Weiss: None.
2University of Medicine and Dentistry of New Jersey, Newark, NJ, USAFull list of author information is available at the end of the article
2012 Srinivasan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License ), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
Srinivasan et al. Pediatric Rheumatology 2012, 10(Suppl 1):A47
Table 1 Factors affecting flare in JIA patients post-ICAI (n=184)
*Median not estimated by SAS; the reported value is the 25th percentile.
**p-value<0.05 was considered statistically significant.
†A significant difference between joint types was found for elbow vs. wriset joint (p=0.0180) after adjusting for multiple testing using a Hochberg procedure.
††A significant difference between JIA subtypes was found for oligoarthritis vs. systemic arthritis (p=0.0015) and between polyarthritis vs. systemic arthritis(p=0.0084) after adjusting for multiple testing using Hochberg procedure.
Table 2 Repeat IACI in JIA patients with arthritis flare
Author details1Hackensack University Medical Center, Hackensack, NJ, USA. 2University ofMedicine and Dentistry of New Jersey, Newark, NJ, USA.
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OCULAR CLUES IN NEUROLOGIC DISEASE Leonid Skorin, Jr., OD, FAAO, DO, FAAO, FAOCO Albert Lea Medical Center - Mayo Health System A. Non-Arteritic Ischemic Optic Neuropathy a. Acute ischemic of the anterior part of the optic nerve (1) arteriosclerosis (2) nocturnal systemic hypotension (3) intensive systemic antihypertensive medication use (4) associated with obstructive sleep apnea (
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