Repost: Joint Injections/knees

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Comparison of Effectiveness of Intra-articular Triamcinolone

Hexacetonide (TH) Compared to Triamcinolone Acetonide (TA) in Knees of

Patients with Juvenile Idiopathic Arthritis (JIA)

Background: Intra-articular corticosteroid injections are a fundamental

part of the treatment of JIA. There is inconclusive evidence suggesting

that TH is the most effective intra-articular preparation. It has been

shown that TH remains for a longer period of time in the joint with less

systemic circulation. Since May 2002 there has been a worldwide shortage

of TH, requiring the use of alternatives.

Objective: To determine if TA is as efficacious as TH in maintaining

remission in injected knee joints of children with JIA.

Material and Methods: Data were collected from charts on all patients

whose knee(s) were injected with either TH or TA between January 2002

and January 2003. Data collected included age, sex, disease diagnosis

(ILAR criteria), corticosteroid dose (mg/kg) and type of corticosteroid.

Patients were followed prospectively every three months and the presence

of either joint swelling, or joint pain on movement were used to

determine the presence of active arthritis. Duration of remission

(defined as the absence of joint swelling and pain on movement) in the

injected knees was compared between groups by independent T test.

Results: Twenty-six patients (34 knees) had intra-articular injections.

Eight patients (9 knees) were not included in the analysis because of

inadequate data or insufficient follow up. Data for 25 injected knees

(18 patients) were analyzed; 17 joints were injected with TH and 8 with TA.

Knees injected with TH had a significantly increased duration of

remission (mean 4.5 months, SD + 4) compared to knees injected with TA

(mean 3 months, SD + 1.3), F =6.979 p value =0.015. There were no

differences in duration of remission in the injected knee by type of

disease, or by use of concomitant medications.

Conclusion: These data suggests that TA is less effective than TH in

suppressing arthritis of the knee in children with JIA.

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Oliva Ortiz-Alvarez, Khairiah A. Alsufyani, A. Cabral, Ross E.

Petty, Lori B. Tucker, Pete N. Malleson. BC's Children's Hospital,

Vancouver, BC, Canada