Objective

Intra-articular corticosteroid injections (IACIs) are frequently used to suppress local inflammation, that is, in children with juvenile idiopathic arthritis (JIA). While systemic high-dosage corticosteroids are known to trigger osteonecrosis and result in osteochondral (OC) lesions, the effect of IACIs on joint cartilage and subchondral bone remains unclear. This study was conceived to analyze the coincidence of IACI and the subsequent manifestation of osteochondral lesions in a large cohort of pediatric JIA patients.

Design

Retrospective data assessment and comparative analysis of skeletally immature JIA patients treated with IACIs between 1993 and 2017.

Results

A total of 280 JIA patients were included in the analysis, the majority were girls (64%). Osteochondral lesions were present in 16 patients (5.7%) at a mean age of 10.7 years (range 4-14 years) and appeared on average after 63-month duration of disease. The majority was present at atypical locations such as the lateral femoral condyle. Multivariable analysis using cox regression showed that steroid injections were a risk factor to develop an OC lesion (hazard ratio [95%CI] for number of steroid injections per year, 8.20 [3.18, 21.16]).

Conclusions

Pediatric patients with JIA show a relatively high incidence of osteochondritic lesions, which present at an early age and in rather atypical locations and repetitive steroid injection need to be considered an associated risk factor.

中文翻译：

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类固醇注射作为幼年特发性关节炎儿童骨软骨病变潜在危险因素的评估。

客观的

关节内皮质类固醇注射 (IACI) 经常用于抑制局部炎症，即用于患有幼年特发性关节炎 (JIA) 的儿童。虽然已知全身性大剂量皮质类固醇会引发骨坏死并导致骨软骨 (OC) 病变，但 IACI 对关节软骨和软骨下骨的影响仍不清楚。本研究旨在分析 IACI 的一致性和随后在一大群儿科 JIA 患者中出现的骨软骨病变。

设计

1993 年至 2017 年间接受 IACI 治疗的骨骼未成熟 JIA 患者的回顾性数据评估和比较分析。

结果

共有 280 名 JIA 患者被纳入分析，其中大多数是女孩（64%）。16 名患者（5.7%）出现骨软骨病变，平均年龄为 10.7 岁（范围 4-14 岁），平均病程 63 个月后出现。大多数存在于非典型位置，例如股骨外侧髁。使用 cox 回归的多变量分析表明，类固醇注射是发生 OC 病变的危险因素（每年类固醇注射次数的风险比 [95%CI] 为 8.20 [3.18, 21.16]）。

结论

患有 JIA 的儿科患者表现出相对较高的骨软骨病变发生率，这种病变出现在年龄较小且相当不典型的部位，并且需要将重复类固醇注射视为相关风险因素。