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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 http://www.ped-rheum.com/content/10/S1/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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