Intra-articular methylprednisolone acetate in the management of chronic arthritis in children king Hussein medical center experience

ABSTRACT

Intraarticular steroid injection in Juvenile Idiopathic arthritis [JIA] has been recently introduced into pediatric rheumatology practice. Much of the evidence supporting its use based on open, non-controlled studies. Patients and methods: We prospectively evaluated the impact of a single intraarticular injection of Methylprednisolone acetate on control of inflammatory arthritis of knee joints in a group of 24 children [30 joints] with Juvenile Idiopathic Arthritis who failed to respond satisfactory to Non-Steroidal Anti-inflammatory Drugs[NSAIDs] with or without slow acting anti-inflammatory drugs. Adverse effects were also evaluated. The study was carried out at the pediatric immunology clinic at King Hussein medical Center [KHMC] between December 1999 to June 2003. Patients aged between 1.5 to 10 years with a mean of 3.39 years. The median duration of follow-up was 24 months. We achieved a significant restoration of the extension function of most joints injected. The mean duration of effect was 18 months for oligoarthritis, and 24 months for juvenile psoriatic arthritis and enthesitis related arthritis compared with 6.75 months for other subtypes. All patients with oligoarthritis who were on oral steroid have discontinued this treatment. This effect was partial or not seen in other subtypes. Relapse rate was higher in patients with systemic- and polyarthritis subtypes. The favorable outcome did not correlate with age, sex or disease duration. The beneficial effect of the injections did not correlate with the presence of antinuclear antibodies [ANA] or ESR. Local adverse effects were few and self-limited with no evidence of systemic toxicity. Intraarticular injection of methylprednisolone acetate appears to be effective, rapid and not associated with significant adverse effects in oligoarthritis, Juvenile Psoriatic arthritis and Enthesitis related arthritis subtypes. On contrary it was found to be less effective in systemic and polyarthritis subtypes