Retrospective analysis of the effectiveness of local corticosteroid therapy in children with oligoarticular juvenile idiopathic arthritis

• Main Authors: A. N. Kozhevnikov, N. A. Pozdeeva, M. S. Nikitin, O. N. Maricheva, T. V. Murashko, N. Yu. Orlova, S. L. Bogdanova, G. A. Novik
• Format: Article
• Language: English
• Published: Siberian State Medical University (Tomsk) 2021-07-01
• Series: Bûlleten' Sibirskoj Mediciny
• Subjects: oligoarticular juvenile idiopathic arthritis; local steroid therapy; triamcinolone acetonide
• Online Access: https://bulletin.tomsk.ru/jour/article/view/4377
• ISSN: 1682-0363; 1819-3684

Background. Despite the progress in diagnosis and treatment of chronic rheumatic diseases in children, the choice of anti-inflammatory drugs in case of the onset of oligoarticular juvenile idiopathic arthritis (JIA) still remains relevant. Till present, pediatric rheumatologists have not reached a  consensus on this issue yet.The aim of this study was to search for predictors of early failure of local steroid therapy and assessment of its feasibility in patients with oligoarticular JIA.Materials and methods. In a retrospective study, 92 children aged 11 months – 9 years with chronic oligoarticular JIA without extra-articular manifestations were monitored. The features of the clinical, instrumental and laboratory diagnosis during the disease onset were studied, along with the dynamics of the articular syndrome and the effectiveness of intra-articular administration of corticosteroid drugs.Results and discussion. The data on 92 children with 164 active joints who received 218 local intra-articular injections of triamcinolone acetonide at the onset of the disease were analyzed. Intra-articular injections of triamcinolone acetonide at a dose of 20–40 mg were performed with an interval of 3, 6, and 12 months, depending on the intensity of the disease. In about one third of children with oligoarticular JIA, arthritis became inactive on average after two intra-articular injections of triamcinolone acetonide. The study did not reveal the predictors of early ineffective topical corticosteroid monotherapy in children. No clinical, instrumental, and laboratory signs were identified that would directly indicate the need for early therapy with  methotrexate.Conclusion. Triamcinolone acetonide is an effective and safe drug for children with oligoarticular JIA. Despite the widespread use of biological, gene, and other innovative therapies, application of local corticosteroids as  the firstline therapy in children with oligoarticular JIA should not be  neglected.