Intravenous regional administration of corticosteroids in juvenile chronic arthritis.

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.