ABSTRACT
Paediatric rheumatology is an exciting field exploding with new knowledge of autoimmune and autoinflammatory conditions and how to treat them. It is, however, a relatively new subspecialisation in Asia. There is thus a great need to educate the public and medical community about paediatric rheumatic diseases so that children with such conditions are given the highest possibility of achieving normal function in their daily lives.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Arthritis, Juvenile , Diagnosis , Therapeutics , Autoimmune Diseases , Diagnosis , Therapeutics , Inflammation , Diagnosis , Therapeutics , Pediatrics , Methods , Rheumatic Diseases , Diagnosis , Therapeutics , Rheumatology , Methods , Singapore , Treatment OutcomeABSTRACT
<p><b>INTRODUCTION</b>This study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA).</p><p><b>METHODS</b>This is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications.</p><p><b>RESULTS</b>A total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking.</p><p><b>CONCLUSION</b>As per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA.</p>