Intra-articular Corticosteroids or Methotrexate for Oligoarticular JIA? Save

Oligoarticular-onset juvenile idiopathic arthritis (JIA) accounts for nearly half of all JIA patients. While many of these children will require DMARD therapy, many others are treated with antiinflammatory meds or intra-articular corticosteroids. But the evidence for this latter approach is scant.

Lancet has published an Italian multicenter study that looked at the effects of  intra-articular corticosteroids alone or in combination with oral methotrexate (15 mg/m2; maximum 20 mg).

This was an open-label, prospective trial. Injectable joints included the shoulder, elbow, wrist, knee, tibiotalar, subtalar or tarsal joints. There were 228 and 262 joint injections in these two groups (respectively) with more elbow and wrist injections in the methotrexate group. Injections were not done with ultrasound guidance.

Patients were randomized to intra-articular corticosteroids alone (n=102) or intra-articular corticosteroids plus methotrexate (n=105).

Remission was observed in 32% on intra-articular corticosteroids alone and 37% who received intra-articular corticosteroids pulse methotrexate. There was no significant difference between groups (p=0·48).

Systemic adverse events were only recorded (17%) in the methotrexate group. There were complications of intra-articular steroids and no patient had a serious adverse event.

The addition of methotrexate did not increase the effectiveness of intra-articular corticosteroid therapy in these children with oligoarticular JIA, thus calling for new studies and alternative approaches for such patients.