The efficacy and safety of intraarticular corticosteroid therapy for coxitis in juvenile rheumatoid arthritis.
OBJECTIVE
To study the efficacy and safety of intraarticular triamcinolone hexacetonide (IATH) for the treatment of coxitis in patients with juvenile rheumatoid arthritis (JRA).


METHODS
Fifty consecutive patients with JRA and coxitis were studied prospectively. Forty-eight children received IATH in 67 arthritic hips. The remaining 2 children exhibited 3 cases of femoral head necrosis (FHN) at the initial assessment and were only followed up; both were receiving long-term systemic steroids. After a minimum of 2 years, the study was concluded with a final evaluation that included magnetic resonance imaging.


RESULTS
In 39 of 67 hip joints (58%), remission of the coxitis for a period of 2 years was obtained through a single administration of IATH, while another 12 hip joints showed remission of coxitis after repeated TH injections (total remission rate 76%). We observed 2 patients with FHN following IATH. Both of these children were receiving long-term systemic steroids. During the period between onset of JRA and screening assessment for this study, the children exhibited 2.4 cases of FHN per 100 patient-years, while 1.5 cases of FHN per 100 patient-years were observed between IATH treatment and final followup. All 5 observed cases of FHN occurred among the 20 children who received long-term systemic steroids, while no necrosis occurred in the 30 children who did not receive systemic corticosteroids (P = 0.009 by Fisher's exact test).


CONCLUSIONS
IATH for juvenile rheumatoid coxitis was an effective treatment that did not increase the rate of FHN. Systemic steroids, however (or their covariable, severity of JRA), may increase the risk of FHN in JRA.
Department of Orthopaedics, Charité University Hospital, Schumannstrasse 20/21, D-10177 Berlin, Germany. jasper.neidel@charite.de
Jasper
J
Neidel
Martina
M
Boehnke
R Michael
RM
Küster
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology; D005500:Follow-Up Studies; D006621:Hip Joint; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012074:Remission Induction; D012307:Risk Factors; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*
D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide