Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Intraarticular corticosteroid injection (IACI) is one of the most common treatment modalities in oligoarticular Juvenile Idiopathic Arthritis (JIA). There is widespread use of IACI in the treatment of arthritis, but recommendations following the procedure vary, as there are no published studies on splinting patients post-IACI. Post-injection, Texas Scottish Rite Hospital for Children (TSRHC) splints patients for 24 hours while The Children’s Hospital of Philadelphia (CHOP) does not. The aim of this study was to compare the number of cases of recurrent arthritis and re-injection following IACI.
Methods
Data (see Table) were retrospectively collected at CHOP and TSRHC. All patients diagnosed with oligoarticular JIA according to ILAR criteria (2nd revision, 2001) between 2008-2010 were included. Chi square and T test were utilized for preliminary analysis.
Results
131 patients at CHOP and 70 patients at TSRHC received a knee IACI. The average age was 9.1 (CHOP) v. 6.7 (TSRHC) (p=0.0002). There were more Hispanics at TSRHC (6 v. 10, p=0.055), and a higher number of ANA positive patients (54 v. 74, p=0.003). Overall mean joint disease severity scores (sum of range of motion restriction, joint swelling and tenderness) at CHOP were higher (3.4 v. 2.3, p <0.001). Mean dose of triamcinolone hexacetonide was higher at CHOP (1.4 mg/kg v 0.8 mg/kg, p<0.001). Arthritis reoccurred in 37 (28%) at CHOP v. 30 (43%) at TSRHC (p=0.041). 37 patients at CHOP received re-injection of the same knee v. 5 at TSRHC (p <0.001).
Conclusion
TSRHC patients were younger and more frequently ANA positive and Hispanic. Joint disease severity scores were higher at CHOP, and patients received a higher mean dose of triamcinolone hexacetonide IACI. The number of recurrent arthritis cases was similar between institutions and there was a trend toward more recurrent arthritis at TSRHC, but CHOP completed a larger amount of repeat injections. This may indicate that TSRHC begins systemic immunosuppression if IACI fails to clinically remit the knee. Future plans include comparison of time to recurrent arthritis to see if splinting extends remission. If it does, the practice of splinting knees following IACI may be beneficial in children with oligoarticular JIA. Examining co-variables such as age, ethnicity, ANA status, disease activity, steroid type and dose, and concomitant medications are planned. Limitations of this study include: 1) possibility that some subjects with oligoarticular JIA were missed; 2) some subjects were lost to follow-up; 3) variation in recording and practice styles. Also, the study only examined knee IACIs, splinting duration was less than reported in adults, and adherence was not monitored.
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Table |
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|
|
|
CHOP n=131 (%) Not splinted post injection |
TSRHC n=70 (%) Splinted post injection |
P |
|
Mean Age (yrs) |
|
9.1 |
6.7 |
0.0002 |
|
Female |
|
108(82) |
58 (83) |
>0.999 |
|
Race |
|
|
|
0.220 |
|
|
White |
110(86) |
66(94) |
|
|
|
Black |
6 (5) |
4 (6) |
|
|
|
Asian |
1 (1) |
0 |
|
|
|
Other* |
11(8.6) |
0 |
|
|
Ethnicity |
|
|
|
|
|
|
Hispanic |
6 (5%, n=117) |
10 (14%, n=70) |
0.055 |
|
|
Not Hispanic |
111 (95%, n=117) |
60 (85%, n= 70) |
|
|
Labs |
|
|
|
|
|
|
ANA + |
74 (57%, 130 tested) |
54 (78%, 69 tested) |
0.003 |
|
|
RF + |
3 (2.3%, 131 tested) |
2 (3%, 70 tested) |
0.741 |
|
|
HLA B 27+ |
7 (5.5%, 128 tested B27) |
3 (4.3%, 70 tested) |
0.750 |
|
|
ESR>20 |
13 (25%, 52 tested) |
22 (35%, 63 tested) |
0.310 |
|
Iritis present |
|
4 (3.1%, n=131) |
2 (3%, n=70) |
0.6344 |
|
Injection dose (mg/kg) |
Triamcinolone Hexacetonide |
1.4 (112) |
0.8 (68) |
<0.001 |
|
Total joint activity (sum of ROM, swelling, tenderness) (mean) |
|
3.4 |
2.3 |
<0.001 |
|
Arthritis reoccurred |
|
37 (28) |
30 (43) |
0.041 |
|
Patients receiving re-injection |
|
37 (31%, n=119) |
5 (7%, n=69) |
<0.001 |
|
Legend: CHOP=The Children’s Hospital of Philadelphia, TSRHC=Texas Scottish Rite Hospital for Children, NSAID=non-steroidal anti-inflammatory drug, ROM=range of motion, CHAQ=Children’s Health Assessment Questionnaire, * Includes: Native American, Hawaiian, other, not specified |
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Disclosure:
E. Ramsay,
None;
H. Benham,
None;
J. Tress,
None;
J. Diaz,
None;
D. D. Sherry,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/retrospective-review-of-immobilization-vs-immediate-resumption-of-activity-in-patients-with-oligoarticular-juvenile-idiopathic-arthritis-and-corticosteroid-knee-injections/