Abstract
BackgroundIntraarticular injections (IAI) were first reported in adult rheumatology in the 1950s and subsequently gained acceptance as a safe and efficacious treatment in Juvenile idiopathic arthritis (JIA). IAIs are now widely performed and recommended as the initial or only treatment of oligoarticular JIA and ancillary treatment of actively inflamed joints in other varieties of JIA. However, the performance of the procedure is currently not guided by standardized recommendations, and several practice variations are observed.MethodsThis worldwide survey of pediatric rheumatologists (with 48.5% response from Pediatric Rheumatology International Trials Organization [PRINTO and Pediatric Rheumatology Collaborative Study Group [PRCSG] members) captures the differences in pre-procedural, procedural and post-procedural protocols and practices observed across the globe and asks the necessity of developing consensus in this area of Pediatric Rheumatology.ResultsThis worldwide survey of Pediatric Rheumatologists had a response rate of just under 50% and the views of about 42% who routinely performed the procedure. It captured the differences in IAI protocols and practices observed across the globe. Significant variations in practice were noted in use of Local anesthesia, choice, and dose of therapeutic agent for the intraarticular injection and use of ultrasound to guide injections. While some practice variations may be explained by institutional protocols in different parts of the world, the clinical implications of these are largely unknown and beg the need for further studies.ConclusionsGiven these practice variations, the authors recommend further studies to explore the cost and clinical implications and subsequently work towards developing consensus plans to ensure uniformity in this widely used procedure in Pediatric Rheumatology.
Highlights
Intraarticular injections (IAI) were first reported in adult rheumatology in the 1950s and subsequently gained acceptance as a safe and efficacious treatment in Juvenile idiopathic arthritis (JIA)
The use of glucocorticoid IAI in newly diagnosed oligoarticular JIA is recommended as the initial therapy in the American College of Rheumatology (ACR) Recommendations for the Treatment of JIA: 2011, irrespective of disease activity and prognostic factors [3]
For oligoarthritis, intraarticular injections are recommended as initial treatment or after failing 2 months of treatment with Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
Summary
Intraarticular injections (IAI) were first reported in adult rheumatology in the 1950s and subsequently gained acceptance as a safe and efficacious treatment in Juvenile idiopathic arthritis (JIA). IAIs are widely performed and recommended as the initial or only treatment of oligoarticular JIA and ancillary treatment of actively inflamed joints in other varieties of JIA. Intraarticular injections (IAIs) are a common practice in Pediatric Rheumatology, for the treatment of Juvenile idiopathic arthritis (JIA). IAI is an accepted initial primary or supplemental tool in management of chronic arthritis in children. The use of glucocorticoid IAI in newly diagnosed oligoarticular JIA is recommended as the initial therapy in the American College of Rheumatology (ACR) Recommendations for the Treatment of JIA: 2011, irrespective of disease activity and prognostic factors [3]. TH continues to be unavailable in several countries and innovative methods of procuring it have been reported [7]
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