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Intra-articular glucocorticoid injections and their effect on hypothalamic–pituitary–adrenal (HPA)-axis function

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Abstract

The use of intra-articular (IA) glucocorticoids for reducing pain and inflammation in patients with osteoarthritis, rheumatoid arthritis, and other inflammatory arthropathies is widespread among primary care physicians, specialists, and non-specialists in the United States. Injectable glucocorticoids have anti-inflammatory and analgesic properties which can be effective in improving clinical parameters such as pain, range of motion, and quality of life. After injection into the IA space, glucocorticoids may be systemically absorbed; the degree of absorption can depend on the size of the joint injected, the injectable glucocorticoid preparation used, the dosage, and the frequency of the injection. The adverse effects of intra-articular glucocorticoid injections (IAGC) can often be overlooked by both the patient and physicians who administer them, in particular the potential deleterious effect on the hypothalamic–pituitary−adrenal (HPA)-axis which can result in adrenal suppression and/or iatrogenic Cushing syndrome. In this paper we provide an overview on the often under-recognized effects of IAGC on HPA-axis function.

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Acknowledgments

We would like to thank Amanda Mendelsohn for providing the illustration from the Center for Medical Art and Photography, Cleveland Clinic Foundation.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, OH, 44195, USA

    Philip C. Johnston, M. Cecilia Lansang & Laurence Kennedy

  2. Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Soumya Chatterjee

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  1. Philip C. Johnston
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Johnston, P.C., Lansang, M.C., Chatterjee, S. et al. Intra-articular glucocorticoid injections and their effect on hypothalamic–pituitary–adrenal (HPA)-axis function. Endocrine 48, 410–416 (2015). https://doi.org/10.1007/s12020-014-0409-5

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