***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The use of intraarticular triamcinolone hexacetonide in the management of persistent arthritis of the knee joint that is unresponsive to nonsteroidal anti-inflammatory drugs was prospect ively evaluated in 40 children with chronic arthritis . Of 49 knees that were injected , 63.3 % maintained complete resolution of effusion and other signs of inflammation at the 6-month followup . This favorable outcome correlated with a young age , a short disease duration , and a higher dose of triamcinolone hexacetonide . At the 12-month followup , 45 % of the injected knees remained in remission Background Children with arthritis may endure a lifetime of disfigurement , dysfunction , and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone . Intraarticular steroids have become an integral component of treatment , but at times are difficult to deliver to joints , such as the subtalar joint , that have complex anatomies . Objective We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis ( JIA ) . Material s and methods Fluoroscopically guided subtalar joint injections were performed in 38 children ( mean age 6.7 years ) . Medical records were review ed retrospectively and improvement was evaluated clinical ly by the degree of foot movement in eversion and inversion . Results Subtalar joint injection was technically successful in 100 % of the JIA patients with improvement in physical symptoms in 34/38 ( 89 % ) . Of the 38 children , 32 were followed up within 13 weeks of the initial injection and , therefore , satisfied the eligibility criteria for resolution of arthritis . Of these 32 children , 14 showed clinical resolution ( 44 % ) . The mean duration of improvement was 1.2 ± 0.9 years . Children with a longer interval ( > 1 year ) from diagnosis to treatment had significantly less resolution ( P = 0.04 ) . Local subcutaneous atrophy or hypopigmentation were observed in 53 % of the children after steroid injection ( 20/38 ) . These minor complications were associated with a greater volume of steroid injected into the site per child ( P = 0.02 ) . Conclusion Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy . Prompt referral for intraarticular steroid treatment in the acute phase improves response . Skin changes often occur at the injection site , and specific pre caution s should be employed to reduce this risk . Prospect i ve study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability OBJECTIVE To compare the efficacy and safety of intra-articular triamcinolone hexacetonide ( TH ) and triamcinolone acetonide ( TA ) in children with oligoarticular juvenile idiopathic arthritis ( JIA ) . METHODS One hundred and thirty joints of 85 patients undergoing intra-articular injections were r and omly treated with either TH or TA depending on the availability of the drug . The efficacy of both treatments was evaluated prospect ively in a blinded fashion . A good response was defined as a decrease in the articular score of > or = 60 % from baseline . Clinical , laboratory and immunological variables were noted in order to examine possible factors , other than treatment , predictive of the result . RESULTS Seventy injections were performed using TH and 60 with TA . The two groups were comparable for clinical , immunological and laboratory characteristics . The rate of response was significantly higher with TH than with TA : 81.4 % vs 53.3 % ( P = 0.001 ) at 6 months , 67.1 vs 43.3 % ( P = 0.006 ) at 12 months , and 60 vs 33.3 % ( P = 0.002 ) at 24 months . CONCLUSION At comparable doses TH appeared to be much more effective than TA for intra-articular use , in both short- and long-term follow-up . This result was not affected by disease duration or degree of local and systemic inflammation OBJECTIVE Pharmacokinetic studies have shown that the biological effect of triamcinolone acetonide ( TA ) is equivalent to that of triamcinolone hexacetonide ( TH ) , if used at double the dosage . In this study we compared the efficacy of intra-articular TA at a dose twice that of TH in symmetrically involved joints , in children with juvenile idiopathic arthritis ( JIA ) . METHOD Children with active arthritis and a similar degree of inflammation in two symmetrical joints were enrolled in the study . The symmetry was assessed by both clinical examination and synovial fluid analysis . The dose given was 1 mg/kg up to 40 mg of TH or 2.0 mg/kg up to 80 mg of TA . The identity of injected compound was blinded to the patient and to the physician . RESULTS Thirty-seven patients , 30 female , seven male , with JIA , entered the study . A total of 86 joints were injected . Twenty-one ( 53.8 % ) of the joints injected with TA  relapsed first compared with only six ( 15.4 % ) of the joints injected with TH . In three ( 7.7 % ) relapse occurred simultaneously . Nine ( 23 % ) were still in remission after 24-month follow-up . The percentage of joints with lasting remission was higher with TH than with TA ( 80 vs 47.5 % after 12 months and 63.6 vs 32.4 % after 24 months , respectively ; log rank test P = 0.003 ) . CONCLUSION Even when TA is given at higher doses , TH is more effective and should be considered the drug of choice for intra-articular treatment of JIA Intraarticular steroid therapy in juvenile chronic arthritis ( JCA ) is performed because of high local efficacy with few side effects . Imaging is used for initial evaluation and for monitoring of treatment response . The aim of this study was to compare imaging findings in diseased hips and knees before and after therapy . A prospect i ve study was performed on 10 patients ( 15 joints ) scheduled for intraarticular therapy .  Pretherapeutic assessment included clinical work-up , radiographs , ultrasound ( US ) , and magnetic resonance imaging ( MRI )  of affected joints . Following therapy ,  clinical and sonographic examinations  were performed at 1 week and 1 month . MRI was repeated at 1 month . MRI and US demonstrated pannus formation and effusion , but differentiation was less distinct on US . Popliteal cysts and lymph nodes were visible in both modalities . MRI additionally revealed articular cartilage loss and subchondral cysts , not shown by US . Epiphyseal overgrowth and osteopenia were best seen radiographically . At present MRI is the best tool to assess the inflammatory changes of the joints in JCA . Initial staging of the joints may be done with plain films and MRI . US is useful to assess effusion and pannus and may be used to monitor treatment response OBJECTIVE To determine in a prospect i ve analysis whether baseline demographic , clinical , and laboratory variables predict the outcome of intraarticular corticosteroid ( IAC ) injection of the knees in children with juvenile idiopathic arthritis ( JIA ) . METHODS We studied consecutive patients who met the criteria for the diagnosis of JIA and received their initial injection of triamcinolone hexacetonide in one or both knees .  Predictor variables included sex , age , age at onset of JIA , onset subtype , disease duration , drug therapy at the time of IAC injection , physician and parent global assessment of disease status , Childhood Health Assessment Question naire disability index , erythrocyte sedimentation rate ( ESR ) , C-reactive protein , involvement of other joints besides knees , amount of fluid aspirated , and dose of IAC injected . The primary outcome measure was persistence of complete clinical response at 6 months , i.e. , no evidence of synovitis clinical ly . RESULTS Ninety-four patients were available for analysis . At 6 months after the IAC injection , 65 ( 69 % ) patients showed a sustained complete clinical response , whereas 29 ( 31 % ) had had a recurrence of joint inflammation . Univariate statistical analyses showed that patients who had a sustained clinical response had a significantly higher ESR than those who did not ( p = 0.023 ) . The ESR was the only variable that remained in the best-fit model from multivariate logistic regression analysis ( OR 2.61 , p = 0.049 ) . CONCLUSION Our findings indicate that patients with JIA who have a higher ESR are more likely to benefit from IAC injection of the knees OBJECTIVE To determine if intraarticular ( i.a . ) injection of triamcinolone hexacetonide ( steroids ) used early in the course of pauciarticular juvenile rheumatoid arthritis ( pauci JRA ) is associated with less leg length discrepancy ( LLD ) or thigh circumference discrepancy ( TCD ) . METHODS Children with pauci JRA who had asymmetric lower-extremity arthritis diagnosed before age 7 years in Seattle , Washington ( WA ; n = 16 ) and in Chapel Hill and Durham , North Carolina ( NC ; n = 14 ) were retrospectively identified . WA children were given i.a . steroids within 2 months of diagnosis ; the injections were repeated if synovitis recurred in the same joint or in a different joint . These children were compared with NC children who were not treated with i.a . steroids .  Thigh circumference was measured at 10 cm above the patella , and leg length was measured from the anterior superior iliac spine to the mid-medial malleolus , by a single observer . LLD and TCD are reported as the percentage of difference between leg measurements in each subject . RESULTS The WA and NC subjects had comparable disease severity and duration of followup ( in months ) . Twelve WA children had subsequent i.a . steroid injections ( mean 3.25 injections per child over mean + /- SD 42 + /- 11 months ) . The WA subjects had significantly less LLD ( P = 0.005 , by Student 's 2-sided t-test ) and prescriptions for shoe lifts ( P = 0.002 , by Fisher 's 2-sided exact test ) . There was not a significant difference in TCD between the 2 groups ( P = 0.139 , by Student 's 2-sided t-test ) . Similar findings were obtained when the analysis was limited to children with monarticular knee arthritis . CONCLUSION Early and continued use of i.a . steroids may be associated with less LLD in young children with pauci JRA . This may indicate decreased duration of synovitis The use of intra-articular steroids in one or both knees was evaluated in 21 children with type 1 pauciarticular juvenile chronic arthritis ( JCA ) . The beneficial effect of the injection was noted within 3 days with no significant adverse reactions . Remission exceeding 6 months was seen in 70 % of the knees and the arthritis remained inactive during the follow up period in 37 % . The beneficial effect of the injection did not correlate with sex , age of onset or the presence of antinuclear antibodies or HLA-B27 antigen and there was no relationship with the size of involved joints at onset , the ESR at onset , or the presence of uveitis . Intra-articular corticosteroids in this type of JCA may provide prompt relief of swelling and pain and reduce the need for other forms of therapy . Remission was long lasting in the majority of the children Both pragmatic and explanatory r and omised controlled trials have a useful role to play in the evaluation of health care interventions . In this descriptive article , the key steps in conducting a pragmatic trial are described . The strengths and limitations of pragmatic trials are also discussed . The main strength of pragmatic trials is that they can evaluate a therapy as it is used in normal practice . Comparisons are made between pragmatic and explanatory trials , on the underst and ing that trials may have aspects to them that make the trial more of a hybrid . A case is made for the appropriate use and relevance of pragmatic trials in the evaluation of alternative and complementary medicine OBJECTIVE To describe radiographic findings at disease onset and 3-year followup in patients with juvenile rheumatoid arthritis ( JRA ) and juvenile spondyloarthropathy ( JSpA ) , to assess radiographic progression and its predictors , and to prospect ively assess clinical outcome and predictors of persistent disease at 3-year followup . METHODS A total of 197 patients with JRA/JSpA were examined every 6 months for 3 years .  Radiographic examination  was performed at baseline and 3-year followup of knees and ankles ( all patients ) and of other joints on clinical indication . Remission was defined as minimum 6 months without medication and no clinical signs of active disease . RESULTS Radiographic abnormalities were found in 88 % of the patients at onset and in 81 % after 3 years . Frequency of swelling/osteoporosis decreased and frequency of abnormal growth increased from baseline to followup . Knees , h and s , and wrists had most frequently radiographic abnormalities . Radiographic progression occurred in 38 % of the patients . Joints with swelling/osteoporosis on radiographs , young age , and a large number of mobility-restricted joints at baseline were predictors of radiographic progression . At 3 years , 26 % of the patients were in remission and 7 
    Output:
    
There was weak evidence for  IACIs decreasing clinical signs and symptoms in the lower leg , improving joint range of motion , decreasing leg length discrepancy , and for imaging techniques detecting the effects of IACIs .
Conclusions There is some weak evidence for the efficacy of  IACIs  improving certain outcome measures .