title: Intra-articular glucocorticoid injections in patients with juvenile idiopathic arthritis in a Singapore hospital.
abstract: BACKGROUND
  This study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA).
  
  
  METHODS
  This is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications.
  
  
  RESULTS
  A total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking.
  
  
  CONCLUSIONS
  As per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA.
authors.forename: Olivia Min Yi
authors.initials: OM
authors.lastname: Leow
authors.forename: Lee Kean
authors.initials: LK
authors.lastname: Lim
authors.forename: Pei Ling
authors.initials: PL
authors.lastname: Ooi
authors.forename: Lynette Pei Chi
authors.initials: LP
authors.lastname: Shek
authors.forename: Elizabeth You Ning
authors.initials: EY
authors.lastname: Ang
authors.affiliation: Division of Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. marybethson@gmail.com.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Son
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D010372:Pediatrics / Q000379:methods; D012189:Retrospective Studies; D012846:Singapore; D012867:Skin / Q000187:drug effects; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide