To study whether intra-articular triamcinolone hexacetonide (iaTH) for the treatment of coxitis in patients with juvenile rheumatoid arthritis (JRA) causes femoral head necroses (FHN).
Fifty consecutive patients with JRA and coxitis were studied prospectively. Forty-eight children received iaTH in sixty-seven arthritic hips. The remaining two children exhibited three cases of femoral head necrosis at the initial assessment and were only followed; both were receiving long-term systemic steroids (LTSS). After a minimum of two years, the study was concluded with a final evaluation including MRI.
In thirty-nine of sixty-seven hip joints (58%), remission of the coxitis for a period of two years was obtained through a single administration of iaTH, another twelve hip joints went into remission after repeated TH injections (total remission rate = 76%). We observed two cases of femoral head necrosis (FHN) following iaTH. Both children were receiving LTSS. During the period between onset of JRA and screening assessment for this study, the children exhibited 2. 4 cases of FHN per 100 patient years vs. 1. 5 cases of FHN per 100 patient years between iaTH treatment and final follow-up. All five observed cases of FHN occurred among the twenty children who received LTSS, whereas no necrosis occurred in the thirty children who did not receive systemic corticosteroids (PÊ=Ê0. 009 Fisher’s Exact Test).
IaTH for juvenile rheumatoid coxitis was an effective treatment which did not increase the rate of FHN. Systemic steroids, however, (or their co-variable, severity of JRA) do increase the risk of FHN in JRA.
