Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy

  • Anindya Diwasasri Universitas Gadjah Mada
  • Sumadiono Sumadiono
  • Sri Mulatsih
Keywords: juvenile idoapathic arthritis, intraarticular injection, remission, disability, early remission time

Abstract

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. It can continue into adulthood and cause severe joint damage, resulting in disability and decreased quality of life.

Objective To determine the predictors of clinical outcomes in JIA patients receiving intra-articular corticosteroid injections (IACS).

Methods We conducted a retrospective cohort study of children with JIA receiving IACS therapy in Dr. Sardjito General Hospital from 1 January 2012 to 31 December 2017 by reviewing data from medical records. The dependent variables were disabilities and early remission time. Independent variables included age at diagnosis, JIA subtype, duration of disease at first diagnosis, timing of IACS, exposure to oral systemic therapy, as well as anti-nuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) test results. External variables were gender and nutritional status.

Results Of 36 patients who received intraarticular corticosteroid injections, 28 (77.8%) experienced remission, and 16 (50%) experienced disabilities. Female subjects (OR 5.296; 95%CI 1.143 to 24.548; P=0.027) and subjects with ESR >26 mm/h (OR 2; 95%CI 1.259 to 3.170; P=0.043) were more likely to have disabilities. Use of oral corticosteroids for ≤3 months and IACS treatment ≤ 3 months after diagnosis were  predictors of early remission time (OR 6.897; 95%CI 1.869 to 25 and OR 3.290; 95%CI 1.195 to 9.091, respectively). However, only oral corticosteroid had a significant correlation in multivariate analysis.

Conclusion Female gender and ESR > 26 mm/h predict disabilities in JIA patients receiving IACS. Duration of oral corticosteroid ≤3 months and early IACS within 3 months of diagnosis correlate to earlier remission time. Shorter duration of oral corticosteroid is the only significant predictor for earlier remission time in JIA patients receiving IACS therapy.

References

1. Marti P, Molinari L, Bolt IB, Seger R, Saurenmann RK. Factors influencing the efficacy of intra-articular steroid injections in patients with juvenile idiopathic arthritis. Eur J Pediatr. 2008;167:425–30.
2. Cunha AL, Miotto e Silva VB, Osaku FM, Niemxeski LB, Furtado RN, Natour J, et al. Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response. Rev Bras Reumatol Engl Ed. 2016;56:490–6.
3. 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.
4. Barsalou J, Hudson M, Duffy CM, Trottier H, Baron M. The impact of early intra-articular corticosteroid injections on the outcome of oligoarticular juvenile idiopathic arthritis. 2014.
5. Sherry DD, Stein LD, Reed AM, Schanberg LE, Kredich DW. Prevention of leg length discrepancy in young children with pauciarticular juvenile rheumatoid arthritis by treatment with intraarticular steroids. Arthritis Rheum. 1999;42:2330–4.
6. Ghrahani R, Setiabudiawan B, Sapartini G, Puspasari H. Distribusi subtipe juvenile idiopathic arthritis di Bandung [Distribution of juvenile idiophatic arthritis subtypes in Bandung]. MKB. 2012;44:101–5.
7. Pribadi A, Akib AAP, Tambunan T. Profil kasus artritis idiopatik juvenil (AIJ) berdasarkan klasifikasi International League Against Rheumatism (ILAR). Sari Pediatr. 2008;9:370–4.
8. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.
9. Gotte AC. Intra-articular corticosteroids in the treatment of juvenile idiopathic arthritis: safety, efficacy, and features affecting outcome. A comprehensive review of the literature. Open Access Rheumatol. 2009;1:37–49.
10. Espinosa M, Gottlieb BS. Juvenile idiopathic arthritis. Pediatr Rev. 2012;33:303–13.
11. Libert C, Dejager L, Pinheiro I. The X chromosome in immune functions: when a chromosome makes the difference. Nat Rev Immunol. 2010;10:594–604.
12. Stavropoulos-Kalinoglou A, Metsios GS, Panoulas VF, Nevill AM, Jamurtas AZ, Koutedakis Y, et al. Underweight and obese states both associate with worse disease activity and physical function in patients with established rheumatoid arthritis. Clin Rheumatol. 2009;28:439–44.
13. Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum. 2000;43:22–9.
14. Grom AA. Juvenile idiopathic arthritis: epidemiology and immunopathogenesis. UpToDate; 2016. [cited 2017-11-06}. Available from: https://www.uptodate.com/contents/juvenile-idiopathic-arthritis-epidemiology-and-immunopathogenesis.
15. McCann LJ. Juvenile idiopathic arthritis. Arch Dis Child - Educ Pract. 2006;91:ep29-ep36.
16. Hyrich KL, Lal SD, Foster HE, Thornton J, Adib N, Baildam E, et al. Disease activity and disability in children with juvenile idiopathic arthritis one year following presentation to paediatric rheumatology. Results from the Childhood Arthritis Prospective Study. Rheumatology (Oxford). 2010;49:116–22.
17. Singh-Grewal D, Schneider R, Bayer N, Feldman BM. Predictors of disease course and remission in systemic juvenile idiopathic arthritis: significance of early clinical and laboratory features. Arthritis Rheum. 2006;54:1595–601.
18. Beukelman T, Arabshahi B, Cahill AM, Kaye RD, Cron RQ. Benefit of intraarticular corticosteroid injection under fluoroscopic guidance for subtalar arthritis in juvenile idiopathic arthritis. J Rheumatol. 2006;33:2330–6.
19. Remedios D, Martin K, Kaplan G, Mitchell R, Woo P, Rooney M. Juvenile chronic arthritis: diagnosis and management of tibio-talar and sub-talar disease. Br J Rheumatol. 1997;36:1214–7.
Published
2019-09-24
How to Cite
1.
Diwasasri A, Sumadiono S, Mulatsih S. Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy. PI [Internet]. 24Sep.2019 [cited 19Mar.2024];59(5):237-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2195
Section
Pediatric Allergy Immunology
Received 2019-04-27
Accepted 2019-09-19
Published 2019-09-24