Genicular Nerve Block in Juvenile Idiopathic Arthritis

Study Overview
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Brief Summary
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N=104 juvenile idiopathic arthritis patients diagnosed after ILAR criteria with unilateral persistent knee arthritis. They will be randomly assigned into two groups; group 1 will receive genicular nerve block, group 2 intra-articular triamcinolone. Both groups will be examined by SOLAR ultrasound scoring system, Visual analogue scale and Lysholm score at 0, 2 and 12 weeks. A semi-quantitative score will be used to assess tenderness and swelling at the same intervals.

Official Title
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Genicular Nerve Block in Juvenile Idiopathic Arthritis

Conditions
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Juvenile Idiopathic Arthritis, Persistent Knee Arthritis, no Intra-articular Injection in the Last 3 Months, no Other Cause for Chronic Kneearthritis

Intervention / Treatment
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* Drug: genicular nerve block
* Drug: intra-articular steroid injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: juvenile idiopathic arthritis with persistent knee arthritis age below 16 Exclusion Criteria: severe knee osteoarthritis peripheral neuropathy, psoriatic arthritis, those under anticoagulant therapy, skin infection, prior knee injection in the last 3 months3 those who have an allergy to Bupivacaine

Ages Eligible for Study
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Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active genicular nerve block group<br>group 1 will receive genicular nerve block. The injection and US examination will be done by two experienced sonographers. They were blinded to clinical data. Patients will also be blinded for the injected substance. Each point will be injected with 2 ml of Lidocaine hydrochloride 2 % (Xylocaine, Astrazeneca). The injection will be done using the 3 point technique (superior medial, superior lateral, and inferior medial genicular nerves). | Drug: genicular nerve block<br>* nerve block of the genicular nerve at 3 points around the inflamed knee using ultrasound.<br>|
| Other: intra-articular steroid injection group<br>while group 2 received intra-articular triamcinolone under ultrasound guidance and through injecting the supra-patellar bursa. | Drug: intra-articular steroid injection<br>* Triamcinilone injection into the knee joint under ultrasound guidance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in SOLAR score over time | score to assess ultrasound parameters of the knee including power doppler and grey scale measures | Baseline, 2 weeks and 12 weeks | 
| Change in visual analogue scale over time | a graded score for pain evaluation filled by the patient graded from 0 to 10 | Baseline, 2 weeks and 12 weeks | 
| Change in Lysholm score over time | a score to assess knee function. This questionnaire has 8 domains. A score between 95 and 100 means excellent functional performance, good 84-94, fair 65-83 and poor <64 | Baseline, 2 weeks and 12 weeks | 
| Change in semiquantitative score for swelling and tenderness over time | A score graded from 0 to 3; score 0 means no swelling nor tenderness and 3 means maximum swelling and tenderness | Baseline, 2 weeks and 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Juvenile rheumatoid arthritis, knee joint, Nerve block