Intra-articular joint injections in juvenile idiopathic arthritis: state of the art.

Abstract

OBJECTIVE:

Intra-articular corticosteroid injections (IACI) are a fundamental part in the treatment of juvenile idiopathic arthritis. The current situation of IACI is reviewed in a population of children.

METHODS:

We conducted a narrative review of the literature related to IACI in children, with respect to the injection technique, use of local and general anesthesia, ultrasound guidance of the procedure, indications, special joints and type of optimal corticosteroid.

RESULTS:

IACI are indicated in any subcategory of juvenile idiopathic arthritis, especially in oligoarticular juvenile idiopathic arthritis. The use of local anesthetic is highly recommended, and in patients younger than 6 years or requiring multiple joint injections, conscious sedation can also be an option. Ultrasound guidance of injections is recommended in expert hands, but not in a generalized way. Triamcinolone hexacetonide is the corticosteroid of choice in large joints, whereas a more soluble corticosteroid is a better alternative in small or superficial joints (betamethasone or methylprednisolone) to avoid subcutaneous atrophy or hypopigmentation, the most frequent adverse effect of IACI.

CONCLUSIONS:

IACI are performed heterogeneously and scientific evidence is limited in many cases.

• Authors: Juan Carlos Nieto-González, Indalecio Monteagudo
• Journal: Reumatologia clinica (Reumatol Clin (Engl Ed)) 2019 Mar - Apr Vol. 15 Issue 2 Pg. 69-72 ISSN: 2173-5743 [Electronic] Spain
• Vernacular Title: Estado actual del tratamiento con infiltraciones intraarticulares en la artritis idiopática juvenil.
• PMID: 30243614 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents

Topics

• Adrenal Cortex Hormones (administration & dosage, therapeutic use)
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• Arthritis, Juvenile (drug therapy)
• Child
• Humans
• Injections, Intra-Articular
• Treatment Outcome
• Ultrasonography, Interventional