Intravenous regional administration of corticosteroids in juvenile chronic arthritis

Abstract

Background Treatment of juvenile chronic arthritis patients with longstanding multiple joint or tendon involvement that is resistant to medication remains a challenge. For 20 years, we have been treating these severely ill patients with intravenous regional glucocorticoids (a modified Bier's block).Patients and methods Since 1996, all juvenile chronic arthritis patients have been followed prospectively by an occupational therapist who has registered the grip strength and range of motion at an average of 6 months after treatment.Results In 22/40 wrists and hands, increased grip strength was recorded. The mean grip strength increased for the whole group from 47 to 59 N and the flexion lag decreased.Interpretation The effect of intravenous regional steroid treatment may be limited from a long-term perspective, but in our series, half of the patients showed a considerable improvement after 6 months. Surgical synovectomy can be postponed and perhaps even be omitted.