A49: Intra‐Articular Corticosteroids Injections in the Lower Extremities: How Do Ankles Respond?

Abstract

Background/Purpose:Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in childhood. Intra‐articular corticosteroids injections (IAS) are a safe and effective therapeutic option for affected children. The response of the ankle joint to IAS is thought to be less favourable than other joints. To date, little evidence is available to support this observation and there is insufficient research evaluating the response of the ankle compared to other joints of the lower extremities.Methods:JIA patients 0–18 years old followed at the Montreal Children's Hospital undergoing IAS (blindly or with fluoroscopy) in the lower extremities from January 1st 2005 to December 30th 2012 were included in a retrospective cohort study. Data obtained through chart review encompassed demographics, IAS method, and response to IAS. Response was evaluated at 6 weeks, 3 months, 6 months, 12 months and 24 months post‐procedure. Patients without available data for at least 3 months following intervention were excluded. Non‐response to IAS was determined within the first 3 months after IAS. Time to flare was assessed in subsequent visits up to 24 months.Results:Data from 70 patients included in our study are presented. Median age at diagnosis was 4.7 years with 64% affected with oligoarthritis and 69% of female gender. Median age at the time of IAS was 7.8 years. Triamcinolone hexacetonide was administered in 98% of cases. IAS were performed in 97 knees, 50 ankles and 20 subtalar joints. At 3 months post IAS, 34.0% of ankles, 15.0% of subtalar joints and 11.3% of knees failed to demonstrate a clinical response. The median time to flare after IAS was 7.7 months for the ankles, 7.8 months for the subtalar joints and 8.1 months for the knees. Only two patients developed a complication (subcutaneous atrophy).Conclusion:To date, we report a higher rate of non‐response following blind IAS ankle injections compared to other lower extremities joints. Future analysis of the entire cohort will assess the factors associated with a non‐response to IAS as well as the factors associated with a longer duration of remission. Our findings may reflect inaccurate needle placement and/or non‐treatment of associated tenosynovitis and suggest the need to modify the approach to IAS in the ankles by performing ultrasound‐guided injections to improve outcomes.