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Effect of Intraarticular Corticosteroid Foot Injections on Walking Function in Children With Juvenile Idiopathic
Anna-Clara Esbjörnsson1, Maura D Iversen2, Marie André1
1Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Insights
Intraarticular corticosteroid injections improved foot pain in children with juvenile idiopathic arthritis (JIA) but did not improve their gait dynamics. Children with polyarticular JIA and walking difficulties require careful monitoring post-treatment.
Area of Science:
- Pediatric Rheumatology
- Orthopedics
- Biomechanical Analysis
Background:
- Juvenile idiopathic arthritis (JIA) commonly affects the feet and ankles, leading to pain and functional limitations.
- Intraarticular corticosteroid injections (IACI) are used to manage inflammation in JIA.
- The impact of IACI on gait dynamics in pediatric JIA patients with foot involvement is not fully understood.
Purpose of the Study:
- To assess changes in gait dynamics and self-reported foot disability after IACI in children with JIA.
- To compare treatment response between children with polyarticular and oligoarticular JIA.
- To identify factors associated with poorer outcomes following IACI.
Main Methods:
- A cohort of 43 children with JIA and foot involvement received IACI for ankle/foot synovitis.
- Gait dynamics and foot-related disability were measured before and at 3 weeks and 3 months post-injection.
- A control group of 40 healthy children was included for comparison.
Main Results:
- Foot-related disability and inflammatory symptoms significantly improved after IACI.
- Gait parameters, including walking speed and ankle power, remained unchanged from pre-treatment levels.
- A reduced ankle to hip power ratio was observed, particularly in children with polyarticular JIA.
Conclusions:
- IACI effectively reduces foot-related disability and inflammation in pediatric JIA.
- Gait dynamics do not show significant improvement following IACI treatment.
- Children with polyarticular JIA and pre-existing walking difficulties may experience less favorable outcomes and require closer follow-up.
Objective:
To evaluate gait dynamics and self-reported foot-related disability before and after treatment with intraarticular corticosteroid injections (IACI) in children with juvenile idiopathic arthritis (JIA) and foot involvement, and determined whether children with polyarticular and oligoarticular disease responded similarly to IACI treatment.
Methods:
Forty-three children (35 girls and 8 boys) with JIA were consecutively recruited (mean ± SD age 11.1 ± 4.2 years, mean disease duration 4.5 ± 3.6 years). Sixty-five percent were diagnosed with polyarthritis. All children received IACI treatment for ankle and/or foot joint synovitis. Fifty-eight percent received additional injections in the knee and/or hip joint. Forty healthy children, matched by age and sex, comprised the control group. Gait dynamics and foot-related disability were assessed before IACI treatment and at 3 weeks and 3 months following the injections.
Results:
Foot-related disability and inflammatory joint symptoms improved following treatment. Gait dynamics were compromised before treatment and did not improve following treatment (mean ± SD nondimensional walking speed 0.49 ± 0.05 in the control group; 0.44 ± 0.07 in the JIA group pretreatment; 0.43 ± 0.10 in the JIA group 3 weeks following treatment; and 0.43 ± 0.07 in the JIA group 3 months following treatment) (P = 0.001 in controls versus pretreatment JIA group, P = 0.45 JIA over time). Mean ± SD ankle power was 3.81 ± 0.67 in the control group; 3.01 ± 1.19 in the JIA group pretreatment; 3.19 ± 1.30 in the JIA group 3 weeks after treatment; and 3.22 ± 1.03 in the JIA group 3 months after treatment (P < 0.001 in controls versus pretreatment JIA group, P = 0.51 JIA over time). The ankle power to hip power ratio was reduced (P = 0.01 in controls versus pretreatment JIA group), indicating a power shift from the ankles to the hips, which was more prominent in children with polyarthritis.
Conclusion:
As a result of IACI treatment, improvements were found in self-reported foot-related disability and inflammatory joint symptoms, but gait dynamics were unchanged. Children with polyarticular disease and those with greater self-reported walking difficulties prior to IACI treatment demonstrated worse outcomes, and children in these groups should be monitored carefully after treatment.
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