Intra-articular corticosteroids for oligoarticular JIA
The approach to managing oligoarticular juvenile idiopathic arthritis (JIA), and the role of intra-articular corticosteroids in it, is described in Management of oligoarticular JIA. Intra-articular corticosteroids are first-line, specialist-initiated therapy for oligoarticular JIA. Triamcinolone hexacetonide is the most effective intra-articular corticosteroid for this indication and can induce remission in injected joints for 12 months or longer. It is not registered for use in Australia but is available via the Special Access Scheme—refer to local protocols for dosing advice.
Intra-articular corticosteroids are best given by someone with experience administering joint injections in children and adolescents. To improve tolerability of the procedure, procedural sedation and analgesia (eg using midazolam or nitrous oxide) is usually used, although some teenagers will not require it. General anaesthesia may be needed for very young children (eg younger than 2 years) or if the child is distressed or having multiple joints injected.
Serial casting or splinting may be used in conjunction with intra-articular corticosteroid therapy if flexion contractures are present.