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. 2022 Nov 25;20(1):107.
doi: 10.1186/s12969-022-00770-y.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

Timothy Hahn  1 , Carrie Daymont  2 , Timothy Beukelman  3 , Brandt Groh  2 , Kimberly Hays, Catherine April Bingham  2 , Lisabeth Scalzi  2 ; CARRA Registry investigators
Collaborators, Affiliations

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

Timothy Hahn et al. Pediatr Rheumatol Online J. .

Erratum in

Abstract

Background: Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

Methods: We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

Results: We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

Conclusion: While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Keywords: Intraarticular steroid injections; Juvenile idiopathic arthritis (JIA); Pediatric rheumatology; Steroids.

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Conflict of interest statement

Dr. Beukelman receives consulting fees from Novartis and UCB. No other authors have any conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flowchart showing numbers of subjects who met inclusion criteria and were treated with IAS at a study visit and then had follow up at 6 and 12 months
See this image and copyright information in PMC

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