Rheumatology Advance Access originally published online on July 13, 2004
Rheumatology 2004 43(10):1288-1291; doi:10.1093/rheumatology/keh313
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Rheumatology Vol. 43 No. 10 © British Society for Rheumatology 2004; all rights reserved
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Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial
Department of Paediatrics and 1 Department of Laboratory Medicine, University Hospital of Padua, Italy and 2 School of Paediatrics and Childhealth, University of Western Australia, Perth, Australia.
Correspondence to: F. Zulian, Rheumatology Unit, Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padova, Italy. E-mail: zulian{at}pediatria.unipd.it
Objective. Pharmacokinetic studies have shown that the biological effect of triamcinolone acetonide (TA) is equivalent to that of triamcinolone hexacetonide (TH), if used at double the dosage. In this study we compared the efficacy of intra-articular TA at a dose twice that of TH in symmetrically involved joints, in children with juvenile idiopathic arthritis (JIA).
Method. Children with active arthritis and a similar degree of inflammation in two symmetrical joints were enrolled in the study. The symmetry was assessed by both clinical examination and synovial fluid analysis. The dose given was 1 mg/kg up to 40 mg of TH or 2.0 mg/kg up to 80 mg of TA. The identity of injected compound was blinded to the patient and to the physician.
Results. Thirty-seven patients, 30 female, seven male, with JIA, entered the study. A total of 86 joints were injected. Twenty-one (53.8%) of the joints injected with TA relapsed first compared with only six (15.4%) of the joints injected with TH. In three (7.7%) relapse occurred simultaneously. Nine (23%) were still in remission after 24-month follow-up. The percentage of joints with lasting remission was higher with TH than with TA (80 vs 47.5% after 12 months and 63.6 vs 32.4% after 24 months, respectively; log rank test P = 0.003).
Conclusion. Even when TA is given at higher doses, TH is more effective and should be considered the drug of choice for intra-articular treatment of JIA.
KEY WORDS: Juvenile arthritis, Intra-articular steroids, Triamcinolone
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