Benefit of fluoroscopically guided intraarticular, long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis.
BACKGROUND
Children with arthritis may endure a lifetime of disfigurement, dysfunction, and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone. Intraarticular steroids have become an integral component of treatment, but at times are difficult to deliver to joints, such as the subtalar joint, that have complex anatomies.


OBJECTIVE
We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis (JIA).


METHODS
Fluoroscopically guided subtalar joint injections were performed in 38 children (mean age 6.7 years). Medical records were reviewed retrospectively and improvement was evaluated clinically by the degree of foot movement in eversion and inversion.


RESULTS
Subtalar joint injection was technically successful in 100% of the JIA patients with improvement in physical symptoms in 34/38 (89%). Of the 38 children, 32 were followed up within 13 weeks of the initial injection and, therefore, satisfied the eligibility criteria for resolution of arthritis. Of these 32 children, 14 showed clinical resolution (44%). The mean duration of improvement was 1.2 +/- 0.9 years. Children with a longer interval (>1 year) from diagnosis to treatment had significantly less resolution (P = 0.04). Local subcutaneous atrophy or hypopigmentation were observed in 53% of the children after steroid injection (20/38). These minor complications were associated with a greater volume of steroid injected into the site per child (P = 0.02).


CONCLUSIONS
Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy. Prompt referral for intraarticular steroid treatment in the acute phase improves response. Skin changes often occur at the injection site, and specific precautions should be employed to reduce this risk. Prospective study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability.
Cahill
Anne Marie
AM
Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. cahill@email.chop.edu
Cho
Sandy S
SS
Baskin
Kevin M
KM
Beukelman
Timothy
T
Cron
Randy Q
RQ
Kaye
Robin D
RD
Towbin
Richard B
RB
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000704:Analysis of Variance; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007270:Injections, Intra-Articular; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones