Factors Influencing the efficacy of intra-articular steroid injections in patients with juvenile idiopathic arthritis
Factors Influencing the efficacy of intra-articular steroid injections in patients with juvenile idiopathic arthritis
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DOI：
10.1007/s00431-007-0525-9
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发表时间：
2008-04-01
影响因子：
3.6
通讯作者：
Saurenmann, Rotraud K.
中科院分区：
文献类型：
--
作者：
Marti, Peter;Molinari, Luciano;Saurenmann, Rotraud K.
对 1997 年 1 月 1 日至 2001 年 12 月 31 日期间在我们诊所接受关节内类固醇注射的所有幼年特发性关节炎 (JIA) 患者进行了回顾性图表审查。本研究的目的是评估关节内类固醇注射 (iaS) 的结果并确定预后因素。在研究期间，对 60 名患者进行了 202 次 iaS，其中 37 名患有少关节型 JIA，15 名患有多关节、类风湿因子阴性 JIA，各 4 名患有全身性和附着点炎相关的 JIA。中位缓解持续时间为 23.1 个月（范围：0-69 个月）。在最后一次随访时，47 名患者的 103 个关节（51%）在中位随访时间 28 个月（范围：1-69 个月）后仍处于缓解状态。对于整个队列，手腕和手指关节的缓解时间较长[风险比 (RR)：0.2]，同时接受甲氨蝶呤治疗（RR：0.28）和附着点炎相关关节炎（RR：0.34）。对于膝关节组，同时使用甲氨蝶呤（RR：0.37）、曲安奈德（RR：0.77）和全身麻醉（RR：0.56）治疗，缓解时间更长。 45 名 iaS (22.3%) 中观察到轻微副作用，2% 的注射部位出现皮肤萎缩，但我们的队列中没有发生重大不良事件。总之，iaS 是一种安全的手术，中位缓解时间为 23.1 个月。伴随甲氨蝶呤治疗且在全身麻醉下进行注射，上肢关节的缓解时间更长。
A retrospective chart review was performed of all patients with juvenile idiopathic arthritis (JIA) followed at our clinic who had an intra-articular steroid injection between 1 January 1997 and 31 December 2001. The aim of the study was to evaluate the outcome of intra-articular steroid injections (iaS) and determine prognostic factors. During the study period, 202 iaS were performed in 60 patients, of whom 37 had oligoarticular JIA, 15 had polyarticular, rheumatoid factor-negative JIA and four each had systemic and enthesitis-related JIA. The median duration of remission was 23.1 months (range: 0-69 months). At last follow-up, 103 joints (51%) of 47 patients were still in remission after a median follow-up time of 28 months (range: 1-69 months). For the total cohort, the remission was longer for wrist and finger joints [risk ratio (RR): 0.2], with concomitant treatment with methotrexate (RR: 0.28) and for enthesitis-related arthritis (RR: 0.34). For the group of knee joints, remission was longer with concomitant treatment with methotrexate (RR: 0.37), with triamcinolone hexacetonide (RR: 0.77) and with general anaesthesia for the procedure (RR: 0.56). Mild side effects were observed in 45 iaS (22.3%), and skin atrophy occurred at the injection site in 2% of injections, but no major adverse event occurred in our cohort. In conclusion, iaS is a safe procedure with a median duration of remission of 23.1 months. The remission was longer in the joints of the upper extremity, with concomitant treatment with methotrexate and when the injection was performed under general anaesthesia.