We read the publication by Nieto-González and Monteagudo1 in Reumatología Clínicawith interest, where a narrative review is undertaken of the literature in connection with the practice of using intra-articular infiltrations with corticoids (IAIC) in patients with juvenile idiopathic arthritis (JIA). We would like to describe the results of a survey of all of the members of the Spanish Paediatric Rheumatology Society (SERPE) in 2017, in which they were asked about their habitual practice in connection with several aspects of the said technique.

The survey consisted of 10 questions devised by the Scientific Committee of the 2017 National Congress of the said society. The questions refer to the medical speciality of the staff who perform IAIC (rheumatologist, paediatrician, rehabilitation doctor or orthopaedic surgeon); the type of JIA used in the said procedure; indication of analgesia and/or sedation during the process; drug(s) used; details of the IAIC technique (asepsis, washing in saline solution, dilution of the corticoid and others); maximum number of joints infiltrated in a single session; maximum number of IAIC in the same joint in one year; recommendations after infiltration; complications after infiltration; and differences between children according to their age. The “SurveyMonkey” platform was used, which makes it possible to create online surveys, (https://es.surveymonkey.com). This platform interprets the replies to surveys and creates basic descriptive statistics for them.

Eighty-five of the 120 members contacted replied. The survey results showed the heterogeneity of the range of professionals who perform IAIC for JIA, as other authors have reported in the past.2 The appended table shows the said results. In general, the answers to the survey reflect the absence of recognised treatment guides for this technique, showing the existence of practice that is “based on art” in the hospitals that treat young people and children with rheumatic diseases. A North American study that was also based on a survey reached similar conclusions.3

This study has several limitations, the chief one of which may be the fact that only 85 or 70% of 120 members responded to the survey. Additionally, not all of the doctors who treat rheumatic diseases in children in our country belong to the SERPE, although the majority do. On the other hand, one potentially interesting analysis was not carried out: to evaluate whether, within the heterogeneous nature of the replies, they could be found to be more homogeneous if classified according to the speciality of the respondent (rheumatologist, paediatrician, rehabilitator or orthopaedic surgeon).

There are other relevant aspects in connection with IAIC technique which we believe were included in the survey. One of these is the increasing importance of ultrasound scan imaging in paediatric rheumatology, as in recent years it has come to be included as another tool4 for use when infiltrating several locations that are considered to be “difficult” (the temporomandibular joint,5 tenosynovitis,6 the tarsal joint7). On the other hand, in all fields of paediatrics sedation-analgesic techniques are being adopted to improve the quality of care for paediatric patients; including IAIC, according to several recent publications.8–10

Although IAIC is not a technique that involves important adverse events and does not require long training to be performed in a sufficiently expert way, the authors believe it necessary to prepare guides or recommendations for the technique, for paediatric and young patients (Table 1).