Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Intra-articular corticosteroid injections (IACI) are a standard treatment in juvenile idiopathic arthritis (JIA). This study assessed response to IACI in a large prospective cohort of children and young people (CYP) recruited at initiation of treatment.
Methods
Participants were in the Childhood Arthritis Prospective Study (CAPS), an on-going prospective inception cohort study in 7 UK paediatric rheumatology centres, recruiting CYP <16 years with new inflammatory arthritis persisting for ≥ 2 weeks. Demographics, disease features, joint count, treatment details, Childhood Health Assessment Questionnaire (CHAQ), physician’s global assessment (PGA), parent’s general evaluation of well-being (PGE), ESR are collected at first presentation, 6 months, then yearly.
Results
Of 1477 CYP recruited to CAPS 759 completed 3 years follow-up and 603 (79.5%) were treated with IACIs. 185 (24.4%) required IACI alone (with a single episode of injection as the only treatment in 100, (13 % of the total cohort) usually the knee in 80 %. Most injected patients required additional treatments, 393 (69.3%) commenced a DMARD or biologic agent. Of these, 93 patients received both DMARD/ biologic and IACI at the same time.
Of the 185 patients treated only with IACI, 85 had more than one episode of injections. For this group the median time to first injection was 14 days (IQR 6.36) and time from first to second injection was 318 days ( IQR 162-525) illustrating a prolonged effect from the first injection.
390 of the 759 patients completing 3 years of follow-up had oligoarticular JIA of whom 332 (85%) received steroid injections, 163 (42%) treated exclusively with IACI 85 (25%) receiving only one episode of injection.
Baseline predictors of the need for DMARD in addition to IACI were a higher total active and limited joint counts, ESR, physician’s global and the CHAQ score (p<0.0001), and pain scores (p<0.003).
Conclusion
Approximately one quarter of patients required monotherapy with IACI alone. Only 13% of all patients and 25% of oligo-articular course patients were managed with a single injection. Higher measures of disease activity were significantly associated with the need for DMARD therapy in addition to IACI.
|
Baseline Characteristics |
Only IACI, only 1 episode (N=100) |
Had IACI plus DMARD (N=393) |
P value |
|
Age (Median, IQR) |
6.75 (3.82, 11.2) |
7.05 (3.3, 10.9) |
0.9 |
|
Female (n, %) |
57 (57) |
276 (70.4) |
0.01 |
|
Ethnicity (White, n, %) |
96 (96) |
364 (92.8) |
0.09 |
|
Disease duration (Median, IQR), months |
5.5 (3.07, 10.4) |
5.4 (2.9, 10.6) |
0.99 |
|
Active joint counts (Median, IQR) |
1 (1, 2) |
4 (1, 8) |
<0.0001 |
|
Limited joint counts (Median, IQR) |
1 (0.5, 1) |
2 (1, 5) |
<0.0001 |
|
PGE (Median, IQR) (100mm VAS) |
19.5 (3, 49) |
27 (9, 50) |
0.1 |
|
PGA (Median, IQR) (100mm VAS) |
20.5 (10, 30) |
36 (21, 60) |
<0.0001 |
|
ESR (Median, IQR) |
9 (5, 25) |
30 (12, 56) |
<0.0001 |
|
CHAQ (Median, IQR) (0-3) |
0.5 (0.125, 1.625) |
1 (0.375, 1.625) |
0.0001 |
|
Pain (Median, IQR) (100mm VAS) |
23 (8, 50) |
45 (16, 65) |
0.003 |
|
Time to 1st steroid injection (days) |
36 (13, 82) |
38.5 (14, 135.5) |
0.60 |
Disclosure:
E. Baildam,
None;
R. Carrasco,
None;
S. Holt,
None;
H. Foster,
None;
L. R. Wedderburn,
None;
A. Chieng,
None;
J. Davidson,
None;
Y. Ioannou,
None;
K. L. Hyrich,
Pfizer Inc,
9,
Abbott Immunology Pharmaceuticals,
9;
W. Thomson,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/intra-articular-corticosteroid-injections-in-juvenile-idiopathic-arthritis-results-from-a-uk-prospective-collaborative-study/