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Bhardwaj U, Bagri NK, Lodha R, Kabra SK, Velpandian T, Pandey RM. Efficacy of Pulse Dexamethasone in non-systemic Juvenile Idiopathic Arthritis: a double-blind randomised controlled trial. Rheumatology (Oxford) 2021; 61:3370-3377. [PMID: 34888654 DOI: 10.1093/rheumatology/keab914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Early aggressive therapy using biologicals is increasingly being used in Juvenile Idiopathic Arthritis (JIA) for early disease remission. Pulse-steroids are used in induction regimes for rheumatic disorders such as systemic lupus erythematosus and systemic JIA; however, no controlled studies demonstrate their use in non-systemic JIA. The objective of the present study was to evaluate the efficacy and safety of pulse dexamethasone therapy in children with treatment-naive non-systemic JIA as early aggressive therapy in resource-limited settings. METHODS 60 treatment-naive children with non-systemic JIA with an active joint count of ≥ 5 and/or involvement of hip or cervical joints were randomised to receive either pulse dexamethasone (3 mg/kg/day, max : 100 mg/d) or placebo (normal saline) for three consecutive days during each visit at 0, 6 ± 2, 12 ± 2 weeks; along with standard therapy (methotrexate and NSAIDs). The use of oral bridge steroids was permissible for persistent severe disease as per pre-defined criteria. The primary outcome was ACR-Pedi 70 response at 16 ± 2 weeks after enrolment in the two groups. RESULTS The proportion of children achieving ACR-Pedi 70 in the two groups, at last follow-up was 11/30 (36.7%) in pulse dexamethasone arm vs 11/28 (39.3%) in the placebo arm (p-value 0.837, RR 0.93, 95% CI 0.48-1.80). We did not observe any significant difference in the proportion of children requiring bridge steroids. Adverse events were comparable in the two groups. CONCLUSION The addition of pulse dexamethasone to standard treatment may not add any advantage in improving ACR-Pedi 70 scores at medium-term follow-up. TRIAL REGISTRATION Clinical Trial Registry-India www.ctri.nic.in CTRI/2018/08/015151.
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Affiliation(s)
- Umang Bhardwaj
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra K Bagri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Thirumurthy Velpandian
- Ocular Pharmacology and Pharmacy Division, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Mimura T, Kondo Y, Ohta A, Iwamoto M, Ota A, Okamoto N, Kawaguchi Y, Kono H, Takasaki Y, Takei S, Nishimoto N, Fujimoto M, Asanuma YF, Mimori A, Okiyama N, Kaneko S, Takahashi H, Yokosawa M, Sumida T. Evidence-based clinical practice guideline for adult Still’s disease. Mod Rheumatol 2018; 28:736-757. [DOI: 10.1080/14397595.2018.1465633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Saitama Medical University, Saitama, Japan
- Center for Intractable Diseases, Saitama Medical University, Saitama, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihide Ohta
- Faculty of Medicine, Saga University, Saga, Japan
| | - Masahiro Iwamoto
- Department of Internal Medicine, Division of Rheumatology/Clinical Immunology, Jichi Medical University, Tochigi, Japan
| | - Akiko Ota
- Department of Social Medicine, Faculty of Medicine, Division of Public Health, Saitama Medical University, Saitama, Japan
| | - Nami Okamoto
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hajime Kono
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinari Takasaki
- Department of Rheumatology, Juntendo University Koshigaya Hospital, Saitama, Japan
| | - Shuji Takei
- Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Norihiro Nishimoto
- Department of Molecular Regulation for Intractable Diseases, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yu Funakubo Asanuma
- Department of Rheumatology and Applied Immunology, Saitama Medical University, Saitama, Japan
| | - Akio Mimori
- Department of Rheumatology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shunta Kaneko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Yokosawa
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Cutolo M. How should morning function in rheumatoid arthritis be assessed? Bibliographic study of current assessment. Scand J Rheumatol 2011; 125:17-22. [PMID: 21529306 DOI: 10.3109/03009742.2011.566436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In patients with rheumatoid arthritis (RA), symptoms of joint stiffness and pain may be most severe in the morning, resulting in impaired ability to carry out normal morning functions. Although morning stiffness was included in the criteria for classification and remission of RA, defined by the American College of Rheumatology (ACR) in 1987, the approach to assessment of this circadian symptom has not been standardized, and other circadian aspects of the disease (i.e. pain, functional ability) were not included. A bibliographic study of papers published in English in the period January 2007 to January 2010 and reporting morning stiffness, pain or function was undertaken to investigate methods of assessing circadian aspects of RA. A total of 73 studies were identified using Medline, including 62 clinical trials. Full papers were obtained for 52 reports of clinical studies (84%), most of which (44/52, 85%) assessed duration of morning stiffness. Only two studies (4%) specified that severity of morning stiffness was assessed, only three (6%) assessed pain in the morning, and none assessed morning functional ability. These findings suggest the need for consistent reporting of a measure to reflect the impaired morning function, arising from joint stiffness and pain that is commonly experienced by patients.
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Affiliation(s)
- M Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
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Onishi H, Saito Y, Sasatsu M, Machida Y. Kinetic analysis of in vitro and in vivo release of prednisolone from the conjugate of glycol-chitosan and succinyl-prednisolone. Int J Pharm 2011; 410:17-22. [DOI: 10.1016/j.ijpharm.2011.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/14/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
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Aizawa-Yashiro T, Oki E, Tsuruga K, Nakahata T, Ito E, Tanaka H. Intravenous immunoglobulin therapy leading to dramatic improvement in a patient with systemic juvenile idiopathic arthritis and severe pericarditis resistant to steroid pulse therapy. Rheumatol Int 2010; 32:1359-61. [DOI: 10.1007/s00296-010-1413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 02/27/2010] [Indexed: 10/19/2022]
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Abstract
Intravenous supra-pharmacological doses of corticosteroids are used in various inflammatory and autoimmune conditions because they are cumulatively less toxic than sustained steroid treatment at lower quantitative dosage. Their action is supposed to be mediated through non-genomic actions within the cell. Common indications for use in children include steroid resistant and steroid dependent nephrotic syndrome, rapidly progressive glomerulonephritis, systemic vasculitis, systemic lupus erythematosus, acute renal allograft rejection, juvenile rheumatoid arthritis, juvenile dermatomyositis, pemphigus, optic neuritis, multiple sclerosis and acute disseminated encephalomyelitis. Methylprednisolone and dexamethasone show similar efficacy in most conditions. Therapy is associated with significant side effects including worsening of hypertension, infections, dyselectrolytemia and behavioral effects. Adequate monitoring is essential during usage.
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