Intraartikuläre Steroidtherapie bei Kindern mit juveniler idiopathischer Arthritis

Abstract

Intra-articular corticosteroid therapy offers prompt pain release and functional improvement for the involved joints in juvenile idiopathic arthritis. It is indicated for children with mono- or oligo-articular disease to reduce the amounts of drug therapy. For patients with polyarthritis, intra-articular injections can bridge the time interval until DMARDs become effective. Important differential diagnoses like septic arthritis, Lyme disease, tumours, osteonecrosis and other diseases must be excluded before injection. The injection should be administered only when the child is adequately sedated. It requires a consequent treatment afterwards which comprises daily physiotherapy and from our experience also load-relief of the joint. Side effects concern periarticular atrophies and intra-articular calcification, rarely crystal synovitis. Joint infections can be minimized with a strict sterile procedure. Depending on the global situation, intra-articular injections offer a success rate of 50 to 90 % for a follow-up of 6 to 24 months.