Nearly 40% of children with oligoarthritis need no other therapy after steroid injection
Click Here to Manage Email Alerts
Key takeaways:
- Approximately 38% of patients with juvenile idiopathic oligoarthritis needed no more therapy after corticosteroid injection.
- Children aged older than 8 years with negative ANA and HLA B27 had the best prognosis.
Nearly 40% of children with oligoarticular juvenile idiopathic arthritis treated with intra-articular corticosteroids required no additional therapy, according to data published in Arthritis Research & Therapy.
The study aimed to bring clarity to the early stages of oligoarthritis, the most common form of juvenile idiopathic arthritis, when parents are worried about long-term outcomes, Mojca Zajc Avramovič, MD, of the Children’s Hospital at University Medical Center Ljubljana in Slovenia, told Healio.
“There were no real predictors which way the disease would take, only to somehow wait and see,” Avramovič said. “We wanted to give more accurate answers to worried parents.”
To achieve this, Avramovič and colleagues conducted a retrospective study of 109 children (mean age at corticosteroid injection, 8 years) at a single center over a mean follow-up period of 4.3 years. Patient outcomes were classified into three groups — those who needed further systemic therapy (either biologic disease-modifying anti-rheumatic drugs or conventional disease-modifying antirheumatic drugs), additional intra-articular corticosteroid injection alone, or no further therapy. Outcome groups were compared using log-rank survival analyses.
Overall, 38.5% of patients required no additional therapy after intra-articular corticosteroid injection, while further therapy consisted of only IAC for 15.5%. Systemic therapy was needed for 45.9% of patients, all but one of whom were treated with methotrexate, with the other receiving sulfasalazine. According to the researchers, those receiving an intra-articular corticosteroid injection in only one joint were less likely to require biologic therapy, a relationship found to be significant through Fisher’s exact test (P = .006).
“For clinicians it is really important that almost 40% of patients who required local therapy for chronic arthritis did not require any other therapy, and further, 15% only required further local therapy,” Avramovič said. “This is good news for clinicians and parents.”
Future need for systemic therapy was predicted by ANA positivity (P = .049, chi square 3.89) and the presence of human leukocyte antigen B27 (P = .05, chi square 3.85), the statistical analysis found. In a subgroup of children aged older than 8 years at the time of the first intra-articular corticosteroid injection, those who were negative for ANA and human leukocyte antigen B27 were less likely to require systemic therapy (P = .05, chi square 3.77).
Avramovič said “it was surprising” to find human leukocyte antigen B27 and ANA positivity were negative predictors.
“The presence of HLA B27 allele had usually been most important only in enthesitis-related arthritis in boys older than 6 years old,” she said. “Our research shows it might be important in all the patients, also the younger ones, and should be assessed in all children with suspected juvenile idiopathic arthritis.”
Avramovič and colleagues wrote that their study was “the first” to evaluate juvenile idiopathic oligoarthritis “from the view of [intra-articular corticosteroid injection (IAC)] as the first treatment.”
“In our cohort more than half of the children with juvenile idiopathic oligoarthritis after first IAC did not require systemic therapy for arthritis and achieved long-term remission off therapy,” they wrote. “This is valuable information for practicing clinician to be able to give this comforting information to the patient/parent.”
Collapse
Read more about
Click Here to Manage Email Alerts