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Splinting After Intra-articular Injection Offers No Clear Benefit in JIA
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Patients with juvenile idiopathic arthritis who were placed in a splint to encourage rest following intra-articular corticosteroid injection, or IACI, demonstrated no significant benefit against recurrent arthritis compared with those who were not given a splint, according to findings published in Pediatric Rheumatology.
“There are currently no studies that systematically examine the different recommendations made post-steroid joint injection in patients with JIA,” Heather Benham, DNP, APRN, CPNP-PC, of Texas Scottish Rite Hospital for Children, told Healio Rheumatology. “Steroid injections are an important part of the treatment regimen for JIA, especially those with oligoarticular JIA. We don’t know if the post-care regimen impacts the outcome of the injection — response of the joint to the steroid — or the risk for adverse events — local dermal atrophy.”
“JIA patients treated at Texas Scottish Rite Hospital for Children (TSRH) with IACI for knee synovitis are immobilized for 24hours post-procedure, to encourage rest, while those at the Children’s Hospital of Philadelphia (CHOP) are instructed to avoid sports the day of injection,” they added.
To compare the two post-IACI procedures in terms of recurrent arthritis cases, Benham and colleagues conducted an observational study of data retrospectively collected at the two medical centers. Participants were children and adolescents aged 0 to 18 years who had been diagnosed with oligoarticular JIA, and received a knee injection between 2008 and 2010. Each patient was followed for 2 years from the date of injection or Dec. 31, 2012, whichever was sooner.
The researchers included 72 patients from CHOP and 95 from TSRH. Characteristics including sex, age, race, ethnicity, age of JIA onset, age of knee symptom onset, presence of iritis and pain measures were recorded. Benham and colleagues used Wilcoxon rank-sum tests and chi-squared tests to analyze the differences in outcomes between the two medical centers. In addition, they used inverse probability of treatment weighted Cox regression to adjust for differences.
According to the researchers, patients at CHOP demonstrated fewer knee arthritis reoccurrences than TSRH: 26% vs. 38% (P = .14). Participants at TSRH were younger (P < .05) and included more whites (P = .03) than at CHOP. In addition, disease duration was significantly longer at TSRH, with 0.4 years, compared with 0.74 years at CHOP (P = .014). More patients at CHOP were receiving biologics at the time of injection (P < .05), and patients at CHOP also had higher baseline physician global for disease activity (P < .001) and joint disease severity (P < .001).
“Based on our results, we cannot make specific recommendations about a certain post-injection regimen,” Benham said. “Since there is some evidence from the adult literature — specifically for steroid injections of knees — that certain post-injection regimens may be more beneficial, it would be helpful to conduct a prospective trial where certain variables could be more controlled and we could better assess compliance, outcomes and adverse events.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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