Almira Cosickic, Adin Alić, Sanimir Suljendic, Amela Selimovic, Maida Skokic, Dina Delibegovic, Mirela Delibegovic


Aim: To evaluate the therapeutic response to triamcinolone acetonide (TA) and triamcinolone hexacetonide (TH) injections in the knee of children with JIA.

Material and methods: 46 joints of 42 children undergoing intra-articular injections were randomly treated with either TH or TA depending on the availability of the drug. A good response was defined as the decrease in articular score of 60% from the baseline and the ultrasound absence of synovitis. Clinical, laboratory variables were noted to examine possible predictive factors of the result.

Results: Of 42 children with JIA, the most common was the oligoarticular persistent form in 24 (57.1%) children. Six-month remission was observed in 21.4 % of children, TA vs. TH: 36.8% vs. 8.7% (p=0.02). The absence of signs of knee inflammation within 12 months was found in 23.8% of children, after the application of TA vs. TH: 31.6% vs. 17.4% (p=0.28). However, long-term, a twenty-four-month remission was achieved in 52.4% of children – in twice as many children after TH (69.9%) than after TA application (31.6%) (p=0.03).  A statistically significant correlation was observed between articular score values and duration of remission after TH application, (r=0.56, p=0.006; 95%CI: 0.145-0.80). Two children developed side effects in the form of subcutaneous atrophy at the site of injection, one girl developed transient crystal synovitis after TH applications.

Conclusion:This study has shown that intraarticular steroid injections are safe for the treatment of joint inflammation in JIA,and TA is effective in short-term follow-up where TH is an optimum choice in long-term follow-up.


Intraarticular steroids, Children, Idiopathic arthritis

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Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, Manners P, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 1998;25(10):1991-4.

Leow OM,Lim LK, Ooi PL, Shek LP, Ang EY, Son MB. Intra-articular glucocorticoid injections in patients with juvenile idiopathic arthritis in a Singapore hospital. Singapore Med J. 2014;55(5):248–52. doi: 10.11622/smedj.2014066.

Jennings H, Hennessy K, Hendry GJ. The clinical effectiveness of intra-articular corticosteroids for arthritis of the lower limb in juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol Online J. 2014;12:23. doi: 10.1186/1546-0096-12-23.

Bloom BJ, Alario AJ, Miller LC. Intra-articular corticosteroid therapy for juvenile idiopathic arthritis: report of an experiential cohort and literature review. Rheumatol Int. 2011;31(6):749-56. doi: 10.1007/s00296-010-1365-x.

D'Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1): e000428. doi: 10.1136/rmdopen-2016-000428.

Ruth NM, Passo MH. Juvenile idiopathic arthritis: management and therapeutic options. Ther Adv Musculoskelet Dis. 2012;4(2):99-110. doi: 10.1177/1759720X11413630.

Zulian F, Martini G, Gobber D, Agosto C, Gigante C, Zacchello F. Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2003;42(10):1254-9. doi: 10.1093/rheumatology/keg358.

Ravelli A, Davì S, Bracciolini G, Pistorio A, Consolaro A, van Dijkhuizen EHP, et al. Intra-articular corticosteroids versus intra-articular corticosteroids plus methotrexate in oligoarticular juvenile idiopathic arthritis: a multicentre, prospective, randomised, open-label trial. Lancet. 2017;389(10072):909-16. doi: 10.1016/S0140-6736(17)30065-X.

Neidel J, Boehnke M, Küster RM. The efficacy and safety of intraarticular corticosteroid therapy for coxitis in juvenile rheumatoid arthritis. Arthritis Rheum. 2002;46(6):1620–8. doi: 10.1002/art.10313.

Cuncha ALG, Miotto E Silva VB, Osaku FM, Niemxeski LB, Furtado RN, Natour J et al. Intra-articular injections in patients with juvenile idiopathic arthritis: factor associated with a good response. Rev Bras Reumatol Engl Ed. 2016;56(6):490-6. doi: 10.1016/j.rbre.2016.01.001.

Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011;63(4):465-82. doi: 10.1002/acr.20460.

Brown GT, Wright FV, Lang BA, Birdi N, Oen K, Stephens D, et al. Clinical responsiveness of self-report functional assessment measures for children with juvenile idiopathic arthritis undergoing intraarticular corticosteroid injections. Arthritis Rheum. 2005;53(6):897–904. doi: 10.1002/art.21599.

Zulian F, Martini G, Gobber D, Plebani M, Zacchello F, Manners P. Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. Rheumatology (Oxford) 2004;43(10):1288–91. doi: 10.1093/rheumatology/keh313.

Ravelli A, Lattanzi B, Consolaro A, Martini A. Glucocorticoids in pediatric rheumatology. Clin Exp Rheumatol. 2011;29(Suppl 68): S148-52.

Lepore L, Del Santo M, Malorgio C, Presani G, Perticarari S, Prodan M, et al. Treatment of juvenile idiopathic arthritis with intra-articular triamcinolone hexacetonide: evaluation of clinical effectiveness correlated with circulating ANA and T gamma/delta + and B CD5+ lymphocyte populations of synovial fluid. Clin Exp Rheumatol. 2002;20(5):719–22.

Martini G, Gobber D, Agosto C, Vianello A, Zulian F.. Comparison between intraarticular triamcinolone hexacetonide and acetonide in oligoarticular JIA. Ann Rheum Dis. 2001;60(Suppl 11): ii, 12.

Lanni S, Bertamino M, Consolaro A, Pistorio A, Magni-Manzoni S, Galasso R, et al. Outcome and predicting factors of single and multiple intra-articular corticosteroid injections in children with juvenile idiopathic arthritis. Rheumatology (Oxford). 2011;50(9):1627-34. doi: 10.1093/rheumatology/ker165.

Papadopoulou C, Kostik M, Gonzalez-Fernandez MI, Bohm M, Nieto-Gonzalez JC, Pistorio A. et al. Delineating the role of multiple intra-articular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era. Arthritis Care Res (Hoboken). 2013;65(7):1112-20. doi: 10.1002/acr.21947.

Heidt C, Grueberger N, Grisch D, Righini-Grunder F, Rueger M, Ramseier L. . The assessment of steroid injections as a potential risk factor for osteochondral lesions in children with juvenile idiopathic arthritis. Cartilage. 2020; doi:1947603520961173.

Kubo H, Oommen PT, Hufeland M, Heusch P, Laws HJ, Krauspe R, et al. Osteochondritis dissecans shows a severe course and poor outcome in patients with juvenile idiopathic arthritis: a matched pair study of 22 cases. Rheumatol Int. 2018;38(9):1705-12. doi: 10.1007/s00296-018-4100-7.



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