P085 A national survey on the practice of intra-articular steroid injections under gas and air in juvenile idiopathic arthritis at tertiary paediatric rheumatology centres across the UK

Background/Aims Intra-articular corticosteroid injections are often the first-line treatment for juvenile idiopathic arthritis (JIA). In paediatric patients, these injections are typically administered under general anaesthesia. However, there is a growing usage of nitrous oxide and oxygen as a form of conscious sedation to perform these injections. We anticipated that there may be a wide variation in practice across the UK, as there is currently no national guideline for the use of nitrous oxide and oxygen to give intra-articular steroid injections in children with JIA. This survey aimed to explore the current practice of performing joint injections under nitrous oxide and oxygen in patients with JIA across tertiary paediatric rheumatology centres in the UK, with a view to create a guideline for performing joint injections under nitrous oxide and oxygen. Methods An online survey consisting of 10 questions was designed using SurveyMonkey and distributed through the BSR clinical affairs email list for the paediatric rheumatology centres in the UK. The survey contained questions addressing the practices and perspectives of paediatric rheumatology centres regarding joint injections under nitrous oxide and oxygen in children with JIA. Results 39 paediatric rheumatologists from 18 different paediatric rheumatology centres replied. 10 centres (55.6%) had a dedicated nitrous oxide and oxygen clinic, while 14 centres (77.8%) had a regular general anaesthetic list for joint injections. Of those with a dedicated nitrous oxide and oxygen clinic, they ran most commonly every week (50%) with up to 3 patients per clinic (70%). Factors influencing a clinician’s decision to use nitrous oxide and oxygen over general anaesthetic included the number of joints to inject (100%), patient age (97.4%) and patient/parent preference (92.3%). 46.2% of clinicians answered they would inject 4 or more joints under nitrous oxide and oxygen and 35.9% of clinicians answered 8 years was the minimum age they would consider using nitrous oxide and oxygen over general anaesthetic. The commonest joints to be considered for injecting under nitrous oxide and oxygen include knees (100%), ankles (94.9%) and elbows (82.1%). Clinicians reported patients and parents favoured nitrous oxide and oxygen over general anaesthetic as it was quicker, less unpleasant and did not require fasting. Conclusion The survey responses were representative of all the tertiary paediatric rheumatology centres in the UK. As anticipated, there is a wide variation between centres as to how and when nitrous oxide and oxygen is used. Multiple factors such as availability of general anaesthetic list, availability of regular nitrous oxide and oxygen clinics, number of joints to inject, age of the child and patient preference are taken into consideration while offering children and young people joint injections under nitrous oxide and oxygen. This survey highlights the need for a guideline to facilitate uniformity of practice across the nation to improve patient care and better use of resources.