Corticosteroids for septic arthritis in children

Area of Science:

• Pediatric rheumatology and infectious diseases.
• Clinical trial methodology and evidence synthesis.

Background:

• Septic arthritis is an acute joint infection causing erosive damage, particularly affecting young children and disadvantaged populations.
• While antibiotics are crucial, inflammation can lead to lasting joint damage.
• Systemic corticosteroids are being investigated as an adjunctive therapy to mitigate these effects.

Purpose of the Study:

• To evaluate the benefits and harms of using corticosteroids alongside standard treatment for pediatric septic arthritis.
• To synthesize evidence from randomized controlled trials (RCTs) on adjunctive corticosteroid therapy in children.

Main Methods:

• Comprehensive search of multiple databases (MEDLINE, Embase, Cochrane, LILACS, WHO, ClinicalTrials.gov, Google Scholar) up to April 2018.
• Inclusion of RCTs involving children (2 months to 18 years) with septic arthritis receiving corticosteroids plus antibiotics or other interventions.
• Independent assessment of study eligibility, data extraction, and risk of bias; GRADE methodology used for evidence assessment.

Main Results:

• Two RCTs (N=149) involving children aged 3 months to 18 years were included, primarily affecting hips and knees.
• Corticosteroids (dexamethasone) showed a potential benefit in reducing pain and improving joint function at 12 months (low-quality evidence).
• A reduction in intravenous antibiotic treatment duration was observed with corticosteroid use; no significant adverse effects reported in one trial.

Conclusions:

• Low-quality evidence suggests corticosteroids may improve pain and function and shorten antibiotic treatment in pediatric septic arthritis.
• Limitations include high risk of attrition bias, selective reporting, and imprecision, precluding strong conclusions.
• Further high-quality randomized clinical trials are needed to confirm these findings and guide clinical practice.