Article type
Year
Abstract
Background: septic arthritis is an acute infection of the joints characterized by erosive disruption of the articular space. The most vulnerable population for septic arthritis includes infants and preschoolers, especially boys. Septic arthritis disproportionately affects populations of low socioeconomic status. Systemic corticosteroids and antibiotic therapy may be beneficial for treating this condition. Even if the joint infection is eradicated by antibiotic treatment, the inflammatory process may produce residual joint damage and sequelae.
Objectives: to assess the effects of corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis.
Search methods: we searched MEDLINE, Embase, CENTRAL (in the Cochrane Library), LILACS, the World Health Organization trials portal, ClinicalTrials.gov and Google Scholar from their inception to 17 April 2018. We included RCTs with patients from two months to 18 years of age with a diagnosis of septic arthritis who were receiving corticosteroids in addition to antibiotic therapy or as an adjuvant to other therapies.
Main results: we included two RCTs involving a total of 149 children between three months and 18 years of age. The most commonly affected joints were hips and knees. In both studies, dexamethasone administered intravenously during four days was the corticosteroid, and the comparator was placebo. The longest follow‐up was one year. Trials did not report activities of daily living nor length of hospital stay. Both studies used adequate processes for randomization, allocation concealment, and blinding, and review authors judged them to be at low risk of selection and performance bias. The risk ratio (RR) for absence of pain at 12 months of follow‐up was 1.33, favouring corticosteroids (95% confidence interval (CI) 1.03 to 1.72; P = 0.03; number needed to treat for an additional beneficial outcome (NNTB) = 13, 95% CI 6 to 139; absolute risk difference 24%, 95% CI 5% to 43%). The RR for normal function of the affected joint at 12 months of follow‐up was 1.32, favouring corticosteroids (95% CI 1.12 to 1.57; P = 0.001; NNTB = 13, 95% CI 7 to 33; absolute risk difference 24%, 95% CI 11% to 37%). We found a reduction in the number of days of intravenous antibiotic treatment favouring corticosteroids (mean difference (MD) −2.77, 95% CI −4.16 to −1.39) based on two trials with 149 participants. There were no demonstrated adverse effects of the intervention.
Conclusions: evidence for corticosteroids as adjunctive therapy in children with septic arthritis is of low quality and is derived from the findings of two trials (N = 149). Corticosteroids may increase the proportion of children without pain and those with normal function of the affected joint at 12 months, and they may also reduce the number of days of antibiotic treatment. However, we cannot draw strong conclusions based upon these trial results.
Objectives: to assess the effects of corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis.
Search methods: we searched MEDLINE, Embase, CENTRAL (in the Cochrane Library), LILACS, the World Health Organization trials portal, ClinicalTrials.gov and Google Scholar from their inception to 17 April 2018. We included RCTs with patients from two months to 18 years of age with a diagnosis of septic arthritis who were receiving corticosteroids in addition to antibiotic therapy or as an adjuvant to other therapies.
Main results: we included two RCTs involving a total of 149 children between three months and 18 years of age. The most commonly affected joints were hips and knees. In both studies, dexamethasone administered intravenously during four days was the corticosteroid, and the comparator was placebo. The longest follow‐up was one year. Trials did not report activities of daily living nor length of hospital stay. Both studies used adequate processes for randomization, allocation concealment, and blinding, and review authors judged them to be at low risk of selection and performance bias. The risk ratio (RR) for absence of pain at 12 months of follow‐up was 1.33, favouring corticosteroids (95% confidence interval (CI) 1.03 to 1.72; P = 0.03; number needed to treat for an additional beneficial outcome (NNTB) = 13, 95% CI 6 to 139; absolute risk difference 24%, 95% CI 5% to 43%). The RR for normal function of the affected joint at 12 months of follow‐up was 1.32, favouring corticosteroids (95% CI 1.12 to 1.57; P = 0.001; NNTB = 13, 95% CI 7 to 33; absolute risk difference 24%, 95% CI 11% to 37%). We found a reduction in the number of days of intravenous antibiotic treatment favouring corticosteroids (mean difference (MD) −2.77, 95% CI −4.16 to −1.39) based on two trials with 149 participants. There were no demonstrated adverse effects of the intervention.
Conclusions: evidence for corticosteroids as adjunctive therapy in children with septic arthritis is of low quality and is derived from the findings of two trials (N = 149). Corticosteroids may increase the proportion of children without pain and those with normal function of the affected joint at 12 months, and they may also reduce the number of days of antibiotic treatment. However, we cannot draw strong conclusions based upon these trial results.
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