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Background Glucocorticoid injections in periarticular sites (PAGI) such as tendons and bursae often complete the local treatment of active disease in juvenile idiopathic arthritis (JIA). However, the use of PAGI and their role in the achievement of disease remission has seldom been studied. Objectives To identify the clinical features of JIA patients treated with PAGI at the study center in a 6 years period, the sites most frequently injected, the frequency of and the time for achieving local remission. Methods Records of JIA patients treated with PAGI at the study center from 2012 were retrospectively reviewed. Demographic and clinical features, including ongoing systemic treatment, sites of injection, procedure setting, type and dosage of glucocorticoid injected, time to achieve local remission (complete or partial when one/some of the injected sites were in remission and one/some showed persistent synovitis), frequency of remission of the injected sites at the last follow-up and side-effects were recorded. Results In a total of 293 procedures 647 tendons and 26 bursae were injected in 191 patients. Most of the patients were females (74%), with ILAR oligoarticular JIA subtype (50% persistent, 23% extended), followed by RF-negative polyarthritis (23.2%), RF-positive polyarthritis (0.7%) and systemic JIA (1.3%), with a median age of 8.2 years (IQ 4.7-11.3) at the PAGI. All procedures were ultrasound-guided, 281 (96%) under general sedation. Acetate methylprednisolone was used in 96% of the procedures (average dosage 0.45 mg/kg/tendon, 0.89 mg/kg/bursa), whereas trimcinolone exacetonide in 4%. In 255 procedures (87%) patients experienced remission in the injected sites after a median of 2.6 months (IQ 1.9-3.5). Forthy-seven patients (24.6%) underwent to repeated injections in the same sites after at least 3 months from the 1st procedure. A total of 96 tendons and 9 bursae were re-injected during 69 procedures (23.5%). At the last follow up, after a median period of 29.4 months (IQ 15-45.48) from PAGI, patients experienced complete local remission in 259 (88.4%) injected procedures and partial local remission in 23 (7.8%). In 53 procedures with repeated injection(s) in the same site(s) (77%), patients were in local remission at the last follow up. In 77 procedures (26.3%) patients presented flare of disease in periarticular sites. Concerning concomitant therapy, at the time of each PAGI 115 patients (39.2%) were not on treatment, 137 (46.7%) were on methotrexate, 29 (9.9%) on methotrexate and biologics, 8 (2.7%) on biologics and 4 (1.5%) received others. Patients were started with a new treatment in around three months following 139 (47.4) procedures due to poor control of disease. In 156 (53.2%) procedures, patients experienced complete/local remission and maintained the same treatment before or after the injection at the last follow up in a median period of 20.8 months (IQ 12.67- 39.35). Of notice, 81.4% of patients who experienced complete remission following the injection were not on concomitant treatment; 85.9% of patients who experienced complete remission at the last follow up did not receive concomitant treatment. In 24 injection procedures (8.2%) patients showed only mild local side effects (atrophy and hypopigmentation). Conclusion PAGI are a safe option in the management of JIA. In our cohort, patients treated with PAGI had more frequently persistent oligoarticular JIA subtype; acetate methylprednisolone was by far the most frequently used glucocorticoid. In 88.4% procedures patients experienced remission at last follow up. However, further investigations are mandatory to assess the role of concomitant therapy in achieving and maintaining remission. Disclosure of Interests Andrea Uva: None declared, Lucilla Rava’: None declared, Hanan Jadoun: None declared, Angela Aquilani: None declared, Fabio Basta: None declared, Rebecca Nicolai: None declared, Fabrizio De Benedetti Grant/research support from: Abbvie, SOBI, Novimmune, Roche, Novartis, Sanofi, Pfizer, Silvia Magni-Manzoni Consultant for: Abbvie, Speakers bureau: Abbvie |
