title: Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era.
abstract: OBJECTIVE
  To investigate the outcome and predicting factors of multiple intraarticular corticosteroid (IAC) injections in children with juvenile idiopathic arthritis (JIA).
  
  
  METHODS
  The clinical charts of patients who received their first IAC injection in ≥3 joints between January 2002 and December 2011 were reviewed. The corticosteroid used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. In each patient, the followup period after IAC injection was censored in case of synovitis flare or at the last visit with continued remission. Predictors included sex, age at disease onset, JIA category, antinuclear antibody (ANA) status, age and disease duration, disease course, general anesthesia, number and type of injected joints, acute-phase reactants, and concomitant systemic medications.
  
  
  RESULTS
  A total of 220 patients who had 1,096 joints injected were included. Following IAC therapy, 66.4% of patients had synovitis flare after a median of 0.5 years, whereas 33.6% of patients had sustained remission after a median of 0.9 years. The cumulative probability of survival without synovitis flare was 50.0%, 31.5%, and 19.5% at 1, 2, and 3 years, respectively. On Cox regression analysis, positive C-reactive protein value, negative ANA, lack of concomitant methotrexate administration, and a polyarticular (versus an oligoarticular) disease course were the strongest predictors for synovitis flare.
  
  
  CONCLUSIONS
  Multiple IAC injection therapy induced sustained remission of joint synovitis in a substantial proportion of patients. A controlled trial comparing multiple IAC injection therapy and methotrexate versus methotrexate and a tumor necrosis factor antagonist is worthy of consideration.
authors: Istituto Giannina Gaslini, Genoa, Italy.
authors: Charalampia
authors: C
authors: Papadopoulou
authors: Mikhail
authors: M
authors: Kostik
authors: Maria Isabel
authors: MI
authors: Gonzalez-Fernandez
authors: Marek
authors: M
authors: Bohm
authors: Juan Carlos
authors: JC
authors: Nieto-Gonzalez
authors: Angela
authors: A
authors: Pistorio
authors: Stefano
authors: S
authors: Lanni
authors: Alessandro
authors: A
authors: Consolaro
authors: Alberto
authors: A
authors: Martini
authors: Angelo
authors: A
authors: Ravelli
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D001688:Biological Products / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007270:Injections, Intra-Articular; D053208:Kaplan-Meier Estimate; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013585:Synovitis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D000077555:Methylprednisolone Acetate; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide; D008775:Methylprednisolone