Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Intra-articular steroids→ Abstract #60

SAFETY AND EFFICACY OF INTRA-ARTICULAR METHYLPREDNISOLONE ACETATE (MA) IN THE WRIST JOINT IN JUVENILE RHEUMATOID ARTHRITIS

B. A. Eberhard,¹ B. S. Gottleib,¹ J. E. Weiss,¹ D. Milojevic,¹ N. T. Ilowite.¹

¹Department of Pediatrics, Schneider Childrens Hospital, New Hyde Park, NY

This center has for many years has used MA as the intra-articular agent of choice in the wrist joint and the small joints of the fingers and toes. The perceived benefit has been a reduction in known side effects from intra-articular steroid use, such as subcutaneous atrophy. This study was undertaken to compare side effects and efficacy of MA as it is used in the wrist joint of patients with juvenile rheumatoid arthritis (JRA) with other commonly used intra-articular steroids.
Seventeen children who had a joint injection with MA into the wrist were compared to 11 children who had either triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA) injected into the wrist joint within the past 2 years (June 2000- June 2002). Charts were reviewed to compare effectiveness of joint injection as measured by arthritis or the need for a re-injection of a joint over a 6 month period. A prolonged response rate was defined as no active arthritis in the joint 6 months after joint injection.
A total of 33 joints were injected in the combined TH and TA group, while 41 joints were injected in the MA group. In the combined TH and TA group, 9 joints (27%) had a response rate less than 3 months, while 10 joints (30%) had a response rate of between 4-6 months and 14 joints (43%) achieved a prolonged remission rate of greater than 6 months. In comparison, in the group who received MA, 12 joints (29%) had a response rate less than 3 months, 5 joints (12%) had a response rate between 4-6 months and 24 joints (59%) had achieved a prolonged remission rate greater than 6 months (p0.05, for all groups).
In comparison there were two recorded instances of subcutaneous atrophy in the combined TH and TA group and none in the MA group. In summary, MA has good efficacy in the wrist joint in patients with JRA when compared to TH and TA and may be associated with a reduction in the incidence of subcutaneous atrophy.