Corticosteroids May Improve Pain and Function in Children With Septic Arthritis

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Corticosteroids may increase the percentage of patients without pain and the percentage of patients with normal function of the affected joint at 12 months.

Adjunctive therapy with corticosteroids may improve measures of pain and function in children with septic arthritis, according to review findings published in the Cochrane Database of Systematic Reviews. However, researchers could not draw strong conclusions based on the low quality of evidence derived from the findings.

In this systematic review, researchers searched major databases for studies that included children age 2 months to 18 years who were treated with antibiotics, in addition to systemic corticosteroid therapy, for septic arthritis. After applying the search criteria, researchers found 5 articles that included 2 randomized controlled trials. These 2 trials included a total of 149 patients with follow-up for a maximum of 52 weeks. 

After analysis, researchers found that the risk ratio for absence of pain in these children was 1.33 (95% CI, 1.03-1.72; P =.03), which favored adjuvant use of corticosteroid therapy. In addition, the investigators reported the risk ratio for proper functioning of affected joints was 1.32 (95% CI, 1.12-1.57; P =.001), which also showed benefit for giving corticosteroids in combination with antibiotic therapy.

The primary limitation of this systematic review was the low quality of included studies, which increased the risk for selective outcome reporting in the results.

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“Corticosteroids may increase the proportion of patients without pain and the proportion of patients with normal function of the affected joint at 12 months,” the researchers wrote.

“Additional randomized clinical trials in children with relevant outcomes are needed,” they concluded.

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Delgado-Noguera MF, Forero Delgadillo JM, Franco AA, Vazquez JC, Calvache JA. Corticosteroids for septic arthritis in children [published online November 21, 2018]. Cochrane Database Syst Rev. 2018;11:CD012125.