Genicular nerve block achieves 12-week improvement in juvenile idiopathic arthritis
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In patients with juvenile idiopathic arthritis, genicular nerve block achieved “equivalent, longer-term improvement,” after 12 weeks compared with steroid therapy, according to data published in Clinical Rheumatology.
“Persistent mono-articular knee arthritis despite remission is relatively common in juvenile idiopathic arthritis (JIA),” Ahmed Elsaman, MD, of Sohag University Hospital, in Egypt, told Healio. “Repeated intra-articular steroid injection for treating knee arthritis or using large steroid doses could be harmful and can lead to significant cartilage loss. Step-up systemic treatment in mono-arthritis could be of a high cost, whereas achieving remission by local therapy is ideal in this case. We aimed at finding an alternative therapeutic approach for persistent knee arthritis in juvenile idiopathic arthritis patients.”
To investigate the impact of genicular nerve blocks in patients with JIA, Elsaman and colleagues randomized eligible patients 1:1 to receive either nerve block (n = 55) or intra-articular triamcinolone (n = 56). Included patients were aged 8 years or older at the time of enrollment and demonstrated JIA with persistent unilateral knee arthritis for at least 3 months. Exclusion criteria were severe knee destruction, ankylosed knee or peripheral neuropathy. Additionally, patients were excluded if they received anticoagulation therapy, demonstrated skin infection, received an injection in the same knee within 6 months or if they had an allergy to lidocaine.
The researchers evaluated patients at baseline as well as after 2 and 12 weeks. The primary outcome measures included pain as measured using the visual analogue scale (VAS), the sonography of large joints in rheumatology (SOLAR) system, and Lysholm scores.
According to the researchers, VAS scores, tenderness, swelling and SOLAR grey scale scores in both groups were significantly reduced after 2 weeks of follow up (P < .05). After 12 weeks, all outcome measures were more reduced in those receiving genicular nerve block than in the triamcinolone group.
“Genicular nerve block is able to control pain and improve function and inflammation of the knee joint in JIA patients,” Elsaman said. “Though steroid attained better results after 2 weeks, genicular nerve block achieved an equivalent longer-term improvement after 12 weeks.
“Despite the relatively short term-effect of this technique, it provides an ideal alternative for steroids with fewer side effects,” he added. "Finally, we can clearly notice that nerve block performance is much better in inflammatory arthritis than in degenerative arthritis.”
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