Clinical Rheumatology

, Volume 26, Issue 4, pp 566–568 | Cite as

Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients

Brief Report

Abstract

The effect of systemic glucocorticosteroids on the metabolism of glucose is well known; however, there are no reports on the effect of intraarticular steroids on the metabolism of glucose in diabetic patients. Controlled or near controlled diabetic patients who have self-monitoring devices for home monitoring of blood glucose with shoulder pain were offered an intraarticular crystalloid steroid injection of 35 mg of methylprednisolone acetate (MPA) at the shoulder joint after failure of pharmacological and physical therapy. Patients were asked to record blood glucose levels before and 2 h after breakfast, lunch, and supper (six times a day) every other day during 1 week before the injection and during the day of the injection, the next day and every other day for 2 weeks after the injection. Fructosamine levels were obtained just before the injection and 2 weeks after the injection. Wilcoxon signed rank test was used to compare the mean glucose levels before with those after the injection. Paired t test was used to compare the mean fructosamine values after the injection with those before the injection. Eighteen patients completed the study. Fifteen had adhesive capsulitis. The mean glucose levels before injection were 165.5, 195.5, 184.6, 199.4, 182.8, and 200.7 mg% before and 2 h after breakfast, lunch, and supper, respectively. There was no significant change between the mean glucose values before and after meals after the injection compared to those before the injection, respectively, except on a few occasions only throughout the study period. Mean fructosamine level before injection was 279 μmol/l±49.8 compared to 275 μmol/l±50.9 after the injection (P=0.125). Intraarticular injection of MPA at the shoulder joint in diabetic patients with shoulder pain has no significant effect on blood glucose levels.

Keywords

Blood glucose Intraarticular Steroids 

References

  1. 1.
    Iwamoto T, Kagawa W, Naito Y, Kuzuhara S, Kujima M (2004) Steroid-induced diabetes and related risk factors in patients with neurologic diseases. Pharmacotherapy 24:508–514PubMedCrossRefGoogle Scholar
  2. 2.
    Panthakalam S, Phatnagar D, Klimiuk P (2004) The prevalence and management of hyperglycemia in patients with rheumatoid arthritis on corticosteroid therapy. Scott Med J 49:139–141PubMedGoogle Scholar
  3. 3.
    Xiao JZ, Ma L, Gao J, Yang ZJ, Xing XY, Zhao HC, Jiao JS, Li GW (2004) Glucocorticosteroid-induced diabetes in severe acute respiratory syndrome: the impact of high dose and duration of methylprednisolone therapy. Zhonghua Nei Ke Za Zhi 43:179–182PubMedGoogle Scholar
  4. 4.
    Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM (2002) Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med 112:487–490PubMedCrossRefGoogle Scholar
  5. 5.
    Weiss JJ, Ting YM (1978) Arthrography-assisted intra-articular injection of steroids in treatment of adhesive capsulitis. Arch Phys Med Rehabil 59:285–287PubMedGoogle Scholar
  6. 6.
    Jacobs LG, Barton MA, Wallace WA, Ferrousis J, Dunn NA, Bossingham DH (1991) Intra-articular distension and steroids in management of capsulitis of the shoulder. BMJ 302:1498–1501PubMedCrossRefGoogle Scholar
  7. 7.
    Dent PB, Walker N (1998) Intra-articular corticosteroids in the treatment of juvenile rheumatoid arthritis. Curr Opin Rheumatol 10:475–480PubMedCrossRefGoogle Scholar
  8. 8.
    Lazarevic MB, Skosey JL, Djordjevic-Denic G, Swedler WI, Zgardic I, Myones BA (1995) Reduction of cortisol levels after single intra-articular and intramuscular steroid injection. Am J Med 99:370–373PubMedCrossRefGoogle Scholar
  9. 9.
    Mader R, Lavi L, Luboshitzky R (2005) Evaluation of the pituitary-adrenal axis function following single intraarticular injection of methylprednisolone. Arthritis Rheum 52:924–928PubMedCrossRefGoogle Scholar
  10. 10.
    Edelman J, Potter JM, Hackett LP (1986) The effect of intra-articular steroids on plasma salicylate concentration. Br J Clin Pharmacol 21:301–307PubMedGoogle Scholar
  11. 11.
    Derendorf H, Mollmann H, Gruner A, Haack D, Gyselby G (1986) Pharmacokinetics and pharmacodynamics of glucocorticoid suspensions after intra-articular administration. Clin Pharmacol Ther 39:313–317PubMedCrossRefGoogle Scholar
  12. 12.
    Lillich JD, Bertone AL, Schmall LM, Ruggles AJ, Sams RA (1996) Plasma, urine and synovial fluid disposition of methylprednisolone acetate and isoflupredone acetate after intra-articular administration in horses. Am J Vet Res 57:187–192PubMedGoogle Scholar
  13. 13.
    Post EM, Moore JD, Ihrke J, Aisenberg J (2000) Fructosamine levels demonstrate improved glycemic control for some children attending a diabetes summer camp. Pediatr Diabetes 1:204–208PubMedCrossRefGoogle Scholar
  14. 14.
    Hulstyn MJ, Weiss A-PC (1993) Adhesive capsulitis of the shoulder. Orthop Rev 22:425–433PubMedGoogle Scholar
  15. 15.
    Fiocco U, Cozzi L, Chieco-Bianchi F, Rigon C, Vezzu M, Favero E, Ferro F, Sfriso P, Rubaltelli L, Nardacchione R, Todesco S (2001) Vascular changes in psoriatic knee joint synovitis. J Rheumatol 28:2480–2486PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  1. 1.Rheumatology ClinicNazareth HospitalNazarethIsrael
  2. 2.Department of MedicineCarmel Medical CenterHaifaIsrael
  3. 3.Family Physician, Clalit Health ServicesGeneral Clinic CNazarethIsrael

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