Chemical Synoviorthesis in Juvenile Idiopathic Arthritis

Abstract

Introduction: Chemical synoviorthesis (CS) is a procedure frequently utilized/used in the management of patients with active arthritis in a limited number of joints. This technique involves the intraarticular administration of a therapeutic agent, such as long-acting corticosteroid. Its use in children is described since 1979. Currently, it is recommended in the oligoarticular form of juvenile idiopathic arthritis (JIA) and also used in the other forms of JIA when refractory arthritis to conservative treatment is present.

Purpose: To assess the efficacy and safety of chemical synoviorthesis in patients with JIA, which had not responded to systemic therapy.

Material: Twenty-six patients (6 males, mean age 13.4 years) who met the ILAR criteria for JIA (2 systemic JIA, 20 oligoarthritis, 1 RF-positive polyarticular JIA, 2 RF-negative polyarticular JIA and 1 psoriatic arthritis) were included in the study. Thirty-seven synoviorthesis were performed from January 2006 to December 2009, using triamcinolone acetonide (35) or hexacetonide(2).

Methods: A retrospective review of patient’s data was performed using a protocol which included demographic information, disease characteristics, evolution and follow-up after synoviorthesis. Microsoft Excel 2003 and SPSS Statistics 17.0 for Windows were used for data organization and analysis.
Results: Mean disease evolution was 27.4 months and mean follow up time was 6.3 years. Relapse occurred in 6 cases. In the oligoarthritis subgroup, 92,9% of the treated joints showed no inflammatory activity in 24 months versus 62,5% in the other subgroups of JIA. Fifteen patients were considered to be in clinical remission, with a tendency for the oligoarthritis subgroup (X2(1) =5.38, p=0,020). Complications of the procedure occurred in 2 cases (subcutaneous atrophy).

Conclusion: We found a positive association between the oligoarthritis subgroup of JIA and clinical remission, despite small sample size. Chemical synoviorthesis is a safe and effective procedure for treatment of arthritis in pediatric patients with JIA, especially in oligoarticular form, strongly suggesting its application as first line therapy in oligoarthritis JIA.

Keywords: Arthritis, Juvenile Rheumatoid; Injections, Intra-Articular; Triamcinolone Acetonide.