Treatment after intra-articular corticosteroid injection in juvenile idiopathic arthritis: a survey within the German Society for Pediatric and Adolescent Rheumatology

There are no evidence-based recommendations for physiotherapeutic aftercare following intraarticular corticosteroid injections (IACI) in patients with juvenile idiopathic arthritis (JIA). Current aftercare strategies in pediatric rheumatology centers have not been systematically recorded. The aim of this survey was to conduct a nationwide representative study of current aftercare strategies in pediatric rheumatology institutions. An online questionnaire regarding aftercare procedures following IACI in JIA patients was developed by physicians and physiotherapists, evaluated by an expert panel, and made available via SurveyMonkey® to 103 institutions with at least one practicing pediatric rheumatologist. The questions focused on: target joints for IACI, injected medications, type of sedation, and patient setting. Fifty-one responses from 49 centers (response rate: 48%) were evaluated. On average, 109 IACI procedures (median 30) are performed annually per facility including: knee (100%), ankle (91%), hand and finger joints (85%), elbow (85%), hip (50%) and shoulder (44%). Injections were performed in 24% and 21% in an outpatient or semi-outpatient setting, respectively 56% were inpatients. Bed rest was not prescribed by 11% of the institutions, 37% on the day of the IACI, 37% for one additional, and 15% for two more days. Following IACI, physiotherapeutic treatment is generally performed at 61% of institutions. Owing to the need for sedation in children, IACI is mostly performed in an inpatient or semi-inpatient setting. Strategies and recommendations significantly differ across centers. Informed by the results of this survey, a comparative review of aftercare programs is planned as a multicenter study.