Rheumatology International

, Volume 9, Issue 6, pp 265–270 | Cite as

Intraarticular corticosteroid injection into rheumatoid arthritis knees improves extensor muscles strength

  • P. Geborek
  • B. Månsson
  • F. A. Wollheim
  • U. Moritz


Eleven arthritic knee joints in seven patients with rheumatoid arthritis were studied before and after intraarticular injection of a corticosteroid preparation. Extensor muscle torque and quantitative electromyography increased on days 7 and 14 after treatment, indicating that muscle function had been inhibited by synovitis. Clinical signs of synovitis, such as pain, range of motion and knee circumference, also improved. Synovial fluid withdrawal alone improved extensor muscle torque. Joints with instability and/or radiological cartilage involvement also improved.

Key words

Rheumatoid arthritis Synovitis Knee joint Extensor torque Local corticosteroid EMG Synovial fluid volume 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hollander JL (1951) The effect of compound F (hydrocortisone) injected into joints. Bull Rheum Dis 2:3–4Google Scholar
  2. 2.
    Hollander JL, Brown EM Jr, Jessar RA, Brown CY (1951) Hydrocortisone and cortisone injected into arthritic joints: comparative effects of and use of hydrocortisone as a local antiarthritic agent. JAMA 147:1629–1635Google Scholar
  3. 3.
    Stevenson CR, Zuckner J, Freyberg RH (1952) Intra-articular hydrocortisone (compound F) acetate: a preliminary report. Ann Rheum Dis 11:112–118Google Scholar
  4. 4.
    Ziff M, Scull E, Ford D, McEwen C, Bunim JJ (1952) Effects in rheumatoid arthritis of hydrocortisone and cortisone injected intra-articularly. Arch Intern Med 90:774–784Google Scholar
  5. 5.
    Hollander JL, Jessar RA, Brown EM (1961) Intra-synovial corticosteroid therapy: a decade of use. Bull Rheum Dis 11:239–240Google Scholar
  6. 6.
    Hollander JL (1970) Intrasynovial corticosteroid therapy in arthritis. Md Med J 19:62–66Google Scholar
  7. 7.
    McCarty DJ (1972) Treatment of rheumatoid joint inflammation with triamcinolone hexacetonide. Arthritis Rheum 15:157–173Google Scholar
  8. 8.
    Fitzgerald RH Jr (1976) Intrasynovial injection of steroids: uses and abuses. Mayo Clin Proc 51:655–659Google Scholar
  9. 9.
    Valtonen EJ (1981) Clinical comparison of triamcinolone hexacetonide and betmetasone in treatment of osteoarthritis of knee-joint. Scand J Rheumatol [Suppl] 41:3–7Google Scholar
  10. 10.
    Allen RC, Gross KR, Laxer RM, Malleson PN, Beauchamp RD, Petty RE (1986) Intraarticular triamcinolone hexacetonide in management of chronic arthritis in children. Arthritis Rheum 29:997–1001Google Scholar
  11. 11.
    Vliet-Daskalopoulou E van, Jentjens T, Scheffeef RTC, and the International Rimexolone (Org 6216) Study Group (1987) Intra-articular rimexolone in the rheumatoid knee: a placebo-controlled, double-blind, multicentre trial of three doses. Br J Rheumatol 26:450–453Google Scholar
  12. 12.
    Hollander JL (1979) Arthrocentesis and intrasynovial therapy. In: McCarthy DJ (ed) Arthritis and allied conditions, 9th edn Lea and Febinger, Philadelphia, pp 402–416Google Scholar
  13. 13.
    Owen DS (1985) Aspiration and injection of joints and soft tissus, chap 37. In: Kelly WN, Harris ED Jr, Ruddy S, Sledge CB (eds) Handbook of rheumatology. Saunders, Philadelphia, pp 546–560Google Scholar
  14. 14.
    Arnett FC, Edworthy SM, Bloch DA (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324Google Scholar
  15. 15.
    Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn. 18:481–491Google Scholar
  16. 16.
    Edström L, Nordemar R (1974) Differential changes in type I and type II muscular fibres in rheumatoid arthritis. Scand J Rheumatol 3:155–160Google Scholar
  17. 17.
    Nordemar R, Lövgren O, Fürst P, Harris RC, Hultman E (1974) Muscle ATP content in rheumatoid arthritis — a biopsy study. Scand J Clin Lab Invest 34:185–191Google Scholar
  18. 18.
    Chamberlain MA, Bruckner FE (1970) Rheumatoid neuropathy. Ann Rheum Dis 29:609–616Google Scholar
  19. 19.
    Stokes M, Young Y (1984) The contribution of reflex inhibition to arthrogenous muscle weakness. Clin Sci 67:7–14Google Scholar
  20. 20.
    Thiselius P (1969) Studies on joint temperature, joint stiffness and muscle weakness in rheumatoid arthritis. An experimental and clinical investigation (thesis). Acta Rheumatol Scand [Suppl] 14:7–106Google Scholar
  21. 21.
    Jones DW, Jones DA, Newham DJ (1987) Chronic knee effusion and aspiration: the effect on quadriceps inhibition. Br J Rheumatol 26:370–374Google Scholar
  22. 22.
    Andrade JR de, Grant CG, Dixon AStJ (1965) Joint distension and reflex muscle inhibition in the knee. J Bone Joint Surg [Am] 47:313–322Google Scholar
  23. 23.
    Palmer DG, Myers DB (1968) Some observations on joint effusions. Arthritis Rheum 11:745–755Google Scholar
  24. 24.
    Machover S, Sapecky AJ (1966) Effect of isometric exercise on quadricepts muscle in patients with rheumatoid arthritis. Arch Phys Med Rehabil 47:737–741Google Scholar
  25. 25.
    Ekholm B, Lövgren O, Alderin M, Fridström M, Sätterström G (1975) Effect of short-term physical training on patients with rheumatoid arthritis. Scand J Rheumatol 4:80–86Google Scholar
  26. 26.
    Danneskiold-Samsoe B, Lynberg K, Risum T, Telling M (1987) The effect of water exercise therapy on patients with rheumatoid arthritis. Scand J Rehabil Med 19:31–37Google Scholar
  27. 27.
    Cuddigan JHP (1985) Quadriceps femoris strength. Rheumatol Rehabil 12:77–83Google Scholar
  28. 28.
    Harcom TM, Lampman RM, Figley Banwell B, Castor CW (1985) Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthritis Rheum 28:32–39Google Scholar
  29. 29.
    Lawrence JH, De Luca CJ (1983) Myoelectrical signal versus force relationship in different human muscles. J Appl Physiol 54:1653–1659Google Scholar
  30. 30.
    Geborek P, Moritz U, Wollheim FA (1990) Joint capsular stiffness in knee arthritis. Relationship to intraarticular volume, hydrostatic pressures, and extensor muscle function. J Rheumatol (in press)Google Scholar
  31. 31.
    Harman JB (1959) Muscular wasting and corticosteroid myopathy. Lancet I:887Google Scholar
  32. 32.
    Perkoff GT, Silber R, Tyler FH, Cartwright GE, Winthrobe MM (1959) Studies in disorders of muscle. XII Myopathy due to administration of therapeutic amounts of 17-hydroxycorticosteroids. Am J Med 26:891–898Google Scholar
  33. 33.
    Coomes EN (1965) Corticosteroid myopathy. Ann Rheum Dis 24:465–472Google Scholar
  34. 34.
    Yates DAH (1963) Muscular changes in rheumatoid arthritis. Ann Rheum Dis 22:342–347Google Scholar
  35. 35.
    Danneskiold-Samsoe B, Grimby G (1986) Isokinetic and isometric muscle strength in patients with rheumatoid arthritis. The relationship to clinical parameters and the influence of corticosteroid. Clin Rheumatol 5:459–467Google Scholar
  36. 36.
    Danneskiold-Samsoe B (1987) Muscle function in women with rheumatoid arthritis. The influence of glucocorticosteroids: a clinical and morphological investigation (thesis). Laegforeningens, Copenhagen, pp 3–58Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • P. Geborek
    • 1
  • B. Månsson
    • 1
  • F. A. Wollheim
    • 1
  • U. Moritz
    • 2
  1. 1.Department of RheumatologyUniversity HospitalLundSweden
  2. 2.Department of Physical MedicineUniversity HospitalLundSweden

Personalised recommendations