Double blind, randomized, placebo-controlled study of dexamethasone therapy for hematogenous septic arthritis in children.
BACKGROUND
Septic arthritis is associated with residual dysfunction in 10 to 25% of affected children. Concentrations of cytokines detected in synovial fluid of children with bacterial arthritis correlate with the severity of inflammation. Treatment with dexamethasone decreased cartilage degradation in experimental Haemophilus influenzae b and Staphylococcus aureus arthritis.


METHODS
To decrease the number of patients with residual dysfunction of the affected joint at the end of therapy and at 6 and 12 months and to speed clinical recovery by the administration of dexamethasone.


METHODS
In a double blind manner we randomly selected 123 children with suspected hematogenous bacterial arthritis to receive dexamethasone or saline for 4 days. Antibiotic therapy was tailored according to age and the recovered pathogen.


RESULTS
Of the 123 children enrolled, 61 were assigned to the dexamethasone group and 62 to the placebo group. Only 50 and 50 patients in each group were evaluable. The 2 groups of patients were comparable with respect to age, sex, duration of symptoms, pathogen, affected joint and therapeutic and diagnostic procedures. Staphylococcus aureus accounted for 67% of the isolates, Haemophilus influenzae type b for 13% and Streptococcus pneumoniae for 9%. Dexamethasone therapy reduced residual dysfunction at the end of therapy, P = 0.000068; at 6 months, P = 0.00007; and at 12 months, P = 0.00053 of follow-up and shortened the duration of symptoms (P = 0.001) during the acute phase. The 26% incidence of residual dysfunction in the control patients was similar to the 25% found in other series.


CONCLUSIONS
A short course of dexamethasone reduced residual joint dysfunction and shortened significantly the duration of symptoms in children with documented hematogenous septic arthritis. These results suggest that a 4-day course of low dose dexamethasone given early benefits children with hematogenous septic arthritis.
Odio
Carla M
CM
Infectious Diseases, Hospital Nacional de Niños, San Jose, Costa Rica.
Ramirez
Tobias
T
Arias
Gloria
G
Abdelnour
Arturo
A
Hidalgo
Isabel
I
Herrera
Marco L
ML
Bolaños
Willy
W
Alpízar
Jorge
J
Alvarez
Patricio
P
D000900:Anti-Bacterial Agents; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology; D017848:Blood-Borne Pathogens; D017024:Chemotherapy, Adjuvant; D016001:Confidence Intervals; D003364:Costa Rica; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010147:Pain Measurement; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003907:Dexamethasone