Local Steroid Injection Treats Tear Gland Inflammation Found in JIA Patient, Study Reports

Local Steroid Injection Treats Tear Gland Inflammation Found in JIA Patient, Study Reports
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People with juvenile idiopathic arthritis (JIA) may develop dacryoadenitis, or inflammation of the tear-producing glands of the eye, a case report found.

Dacryoadenitis can be effectively treated with a local injection of a corticosteroid directly into the affected tissue, the report also showed.

The study, “Dacryoadenitis Associated With Juvenile Idiopathic Arthritis,” was published in the journal Ophthalmic Plastic and Reconstructive Surgery.

Diverse inflammatory disorders are frequently associated with orbital inflammation, which refers to a benign inflammation in the orbits, or eye sockets. One such disorder that leads to this type of inflammation in children is JIA.

Dacryoadenitis is the most common type of orbital inflammation in children with a systemic inflammatory disease. However, only two cases of JIA associated with dacryoadenitis have been detailed in published reports to date.

A team with the department of ophthalmology at University of California San Francisco described the case of a 14-year-old Caucasian girl with idiopathic JIA who came down with dacryoadenitis.

She had been diagnosed with oligoarticular JIA at age 2, which was well controlled using subcutaneous (under-the-skin) injections of etanercept — marketed as Enbrel by Amgen — at 25 mg twice a week.

Prior to coming to the clinic, she was given antibiotics for a suspected case of orbital cellulitis (inflammation of eye tissues, most commonly caused by an acute infection).  This treatment did not ease her symptoms.

She then moved to oral prednisolone (30 mg/day), but treatment response was again poor.

The patient came with complaints of recurrent left-sided orbital swelling and pain going on for five months. Her left upper eyelid showed ptosis (drooping), edema (swelling), and tenderness.

Examination of the right eye did not find any alterations. A technique called contrast enhanced magnetic resonance imaging (MRI) showed significant enlargement of the left lacrimal gland (which secretes tears) with extensive inflammation.

She underwent a lacrimal gland biopsy, then an anti-inflammatory steroid known as Kenalog was injected into the lesion. Analysis showed preserved lacrimal gland structure. Neither blood vessel inflammation nor blood clots were seen, findings in line with mild chronic inflammation, the investigators said.

The girl reported prompt resolution of her symptoms after steroid injection, and remained free of symptoms over the following six months of evaluations.

These results are consistent with those of previous studies, the team reported, which have shown that corticosteroid injection into the orbital lesion is more effective for localized and non-infectious orbital inflammation than are systemic corticosteroids.

Side effects associated with systemic corticosteroid therapy — such as hypertension, high blood sugar levels, weight gain, and gastritis (inflammation of the protective lining of the stomach) — also make local injection of steroids an alternative first-line approach, the investigators said.

“Intraorbital injection of a corticosteroid is an effective treatment option and may be considered first choice of treatment after excluding other infectious causes of dacryoadenitis,” they wrote.

Iqra holds a MSc in Cellular and Molecular Medicine from the University of Ottawa in Ottawa, Canada. She also holds a BSc in Life Sciences from Queen’s University in Kingston, Canada. Currently, she is completing a PhD in Laboratory Medicine and Pathobiology from the University of Toronto in Toronto, Canada. Her research has ranged from across various disease areas including Alzheimer’s disease, myelodysplastic syndrome, bleeding disorders and rare pediatric brain tumors.
Total Posts: 11

José holds a PhD in Neuroscience from Universidade of Porto, in Portugal. He has also studied Biochemistry at Universidade do Porto and was a postdoctoral associate at Weill Cornell Medicine, in New York, and at The University of Western Ontario in London, Ontario, Canada. His work has ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease.

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Iqra holds a MSc in Cellular and Molecular Medicine from the University of Ottawa in Ottawa, Canada. She also holds a BSc in Life Sciences from Queen’s University in Kingston, Canada. Currently, she is completing a PhD in Laboratory Medicine and Pathobiology from the University of Toronto in Toronto, Canada. Her research has ranged from across various disease areas including Alzheimer’s disease, myelodysplastic syndrome, bleeding disorders and rare pediatric brain tumors.
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