Ultrasound-guided corticosteroid injection therapy for juvenile idiopathic arthritis: 12-year care experience

Department of Radiology and The Children's Radiological Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA, .
Pediatric Radiology (Impact Factor: 1.57). 09/2012; 42(12). DOI: 10.1007/s00247-012-2487-y
Source: PubMed


Intra-articular corticosteroid injections are a safe and effective treatment for patients with juvenile idiopathic arthritis. The potential scope of care in ultrasound-guided corticosteroid therapy in children and a joint-based corticosteroid dose protocol designed to optimize interdisciplinary care are not found in the current literature.
The purpose of this study was to report the spectrum of care, technique and safety of ultrasound-guided corticosteroid injection therapy in patients with juvenile idiopathic arthritis and to propose an age-weight-joint-based corticosteroid dose protocol.
Materials and methods
A retrospective analysis was performed of 198 patients (ages 21 months to 28 years) referred for treatment of juvenile idiopathic arthritis with corticosteroid therapy. Symptomatic joints and tendon sheaths were treated as prescribed by the referring rheumatologist. An age-weight-joint-based dose protocol was developed and utilized for corticosteroid dose prescription.
A total of 1,444 corticosteroid injections (1,340 joints, 104 tendon sheaths) were performed under US guidance. Injection sites included small, medium and large appendicular skeletal joints (upper extremity 497, lower extremity 837) and six temporomandibular joints. For patients with recurrent symptoms, 414 repeat injections were performed, with an average time interval of 17.7 months (range, 0.5–101.5 months) between injections. Complications occurred in 2.6% of injections and included subcutaneous tissue atrophy, skin hypopigmentation, erythema and pruritis.
US-guided corticosteroid injection therapy provides dynamic, precise and safe treatment of a broad spectrum of joints and tendon sheaths throughout the entire pediatric musculoskeletal system. An age-weight-joint-based corticosteroid dose protocol is effective and integral to interdisciplinary care of patients with juvenile idiopathic arthritis.

20 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE To describe the technique for, and evaluate the safety and efficacy of treating the subtalar joint with ultrasound guided corticosteroid injections in patients with juvenile idiopathic arthritis. METHOD AND MATERIALS A retrospective analysis was performed of 68 patients (age 1 – 26 years), with known juvenile idiopathic arthritis, who were referred by a pediatric rheumatologist for corticosteroid injection therapy for symptoms related to the hindfoot and/or ankle. In these patients, the diseased subtalar joint was targeted for therapy, often in conjunction with adjacent affected joints and/or tendon sheaths of the ankle. To access the subtalar joint, the ultrasound probe is placed in an oblique coronal plane just anterior and distal to the lateral malleolus with the foot held in slight supination. The needle is advanced into the joint in a plane perpendicular to the long axis of the probe, using a freehand technique. An age-weight-joint-based dose protocol was utilized for triamcinolone hexacetonide or triamcinolone acetonide dose prescription. RESULTS A total of 135 subtalar joint corticosteroid injections were performed under ultrasound guidance. These included 39 repeat injections for recurrent symptoms in 16 of the 68 patients (average of 2.4 repeat injections). The average time interval between repeat injections was 17.2 months (range, 2.2 - 50.9 months). Atrophy of overlying subcutaneous soft tissues was the only complication reported, occurring in 2.3% of subtalar injections. CONCLUSION With appropriate training and practice, the subtalar joint can be targeted reliably and safely with ultrasound guided corticosteroid injection to provide effective treatment of symptoms related to juvenile idiopathic arthritis. CLINICAL RELEVANCE/APPLICATION The subtalar joint can be difficult to access for treatment of juvenile idiopathic arthritis but ultrasound guidance facilitates safe and accurate joint-targeted therapy.
    No preview · Conference Paper · Dec 2011
  • [Show abstract] [Hide abstract]
    ABSTRACT: The term juvenile idiopathic arthritis (JIA) encompasses a heterogeneous group of arthritides with no known cause that begin before the age of 16 years and persist for at least 6 weeks. In recent decades, imaging techniques have acquired a fundamental role in the diagnosis and follow-up of JIA, owing to the unification of the different criteria for classification, which has strengthened the research in this field, and to the development of disease-modifying antirheumatic drugs. In this article, we briefly explain what JIA is. Moreover, we describe the role and limitations of plain-film radiography, ultrasonography, and magnetic resonance imaging (MRI). Finally, we review the MRI protocol and findings, and we comment on the differential diagnosis.
    No preview · Article · Jan 2013 · Radiología
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ultrasound is an excellent tool to evaluate many pediatric musculoskeletal conditions. It may be used for both diagnosis and for guidance for therapeutic procedures. With US, the radiologist can readily evaluate the contralateral side for comparison. No sedation is typically required and ionizing radiation is avoided. Real-time information is obtained with US and the portability of US allows for the performance of bedside interventions in children who cannot be transported or are clinically unstable. Limitations of US compared with MRI and CT include limited field of view, inability to evaluate the bone marrow and user dependence of image and exam quality. In this article, we discuss common US-guided musculoskeletal procedures in children, including hip aspiration, joint injection, soft-tissue biopsy and foreign body removal.
    No preview · Article · Mar 2013 · Pediatric Radiology
Show more