title: Ultrasound-guided corticosteroid injection therapy for juvenile idiopathic arthritis: 12-year care experience.
abstract: BACKGROUND
  Intra-articular corticosteroid injections are a safe and effective treatment for patients with juvenile idiopathic arthritis. The potential scope of care in ultrasound-guided corticosteroid therapy in children and a joint-based corticosteroid dose protocol designed to optimize interdisciplinary care are not found in the current literature.
  
  
  OBJECTIVE
  The purpose of this study was to report the spectrum of care, technique and safety of ultrasound-guided corticosteroid injection therapy in patients with juvenile idiopathic arthritis and to propose an age-weight-joint-based corticosteroid dose protocol.
  
  
  METHODS
  A retrospective analysis was performed of 198 patients (ages 21 months to 28 years) referred for treatment of juvenile idiopathic arthritis with corticosteroid therapy. Symptomatic joints and tendon sheaths were treated as prescribed by the referring rheumatologist. An age-weight-joint-based dose protocol was developed and utilized for corticosteroid dose prescription.
  
  
  RESULTS
  A total of 1,444 corticosteroid injections (1,340 joints, 104 tendon sheaths) were performed under US guidance. Injection sites included small, medium and large appendicular skeletal joints (upper extremity 497, lower extremity 837) and six temporomandibular joints. For patients with recurrent symptoms, 414 repeat injections were performed, with an average time interval of 17.7 months (range, 0.5-101.5 months) between injections. Complications occurred in 2.6% of injections and included subcutaneous tissue atrophy, skin hypopigmentation, erythema and pruritis.
  
  
  CONCLUSIONS
  US-guided corticosteroid injection therapy provides dynamic, precise and safe treatment of a broad spectrum of joints and tendon sheaths throughout the entire pediatric musculoskeletal system. An age-weight-joint-based corticosteroid dose protocol is effective and integral to interdisciplinary care of patients with juvenile idiopathic arthritis.
authors.affiliation: Department of Radiology and The Children's Radiological Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. cody.young@nationwidechildrens.org
authors.forename: Cody M
authors.initials: CM
authors.lastname: Young
authors.forename: William E
authors.initials: WE
authors.lastname: Shiels
authors.forename: Brian D
authors.initials: BD
authors.lastname: Coley
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hogan
authors.forename: James W
authors.initials: JW
authors.lastname: Murakami
authors.forename: Karla
authors.initials: K
authors.lastname: Jones
authors.forename: Gloria C
authors.initials: GC
authors.lastname: Higgins
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rennebohm
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007270:Injections, Intra-Articular / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents