Skip to main content

Advertisement

SpringerLink
Log in

Intraartikuläre Injektion mit Kortison

Intra-articular injection of cortisone

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Bei vielen rheumatischen Erkrankungen gehören intraartikuläre Injektionen mit Kortison in entzündete Gelenke zur leitliniengemäßen Standardtherapie. Auch in Strategiestudien zur Behandlung der rheumatoiden Arthritis haben intraartikuläre Injektionen mit Kortison heute einen zunehmenden Stellenwert, da mit alleiniger systemischer Medikation das Therapieziel einer Remission oft nicht erreicht wird. In der Kinder- und Jugendrheumatologie kommt dieser Therapieform eine ganz wesentliche Bedeutung zu. Die Kompetenz zur Durchführung von intraartikulären Injektionen gehört in vielen Ländern zur Voraussetzung zur Zertifizierung zum Rheumatologen.

Abstract

Intra-articular injections with glucocorticoids are standard procedures according to therapy guidelines in many rheumatic conditions. There is increasing evidence from clinical trials on the treatment of rheumatoid arthritis that more patients will attain the target of remission using a combination of systemic medication and intra-articular injections with glucocorticoids compared to systemic medication alone. Intra-articular injections with glucocorticoids play an important role in the therapeutic management of pediatric rheumatic diseases. In many countries competency in performing intra-articular injections is among the important skills necessary for certification as a specialist in rheumatology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Braun J, Berg R van den, Baraliakos X et al (2011) 2010 Update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 70:896–904

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Breit W, Frosch M, Meyer U et al (2000) A subgroup-specific evaluation of intraarticular triamcinolone hexacetonide in juvenile chronic arthritis. J Rheumatol 27:2696–2702

    CAS  PubMed  Google Scholar 

  3. Cleary AG, Murphy HD, Davidson JE (2003) Intraarticular corticosteroid injections in juvenile idiopathic arthritis. Arch Dis Child 88:192–196

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Combe B, Landewe R, Lukas C et al (2007) EULAR-recommendations for the management of early arthritis. Ann Rheum Dis 66:34–35

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Dückers G, Guellac N, Arbogast M et al (2012) Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis. Clin Immunol 142:176–193

    Article  Google Scholar 

  6. Eberhard BA, Sison MC, Gottlieb BS, Ilowite NT (2004) Comparison of the intraarticular effectiveness of triamcinolone-hexacetonide and traimcinolone-acetonide in treatment of juvenile rheumatoid arthritis. J Rheumatol 31:2507–2512

    CAS  PubMed  Google Scholar 

  7. Ganser G, Schwarz T (2014) Primär intraartikuläre Steroide versus primäre Biologika bei der polyartikulär verlaufenden juvenilen idiopathischen Arthritis. 24. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR) 2014, Düsseldorf

  8. Gossec L, Smolen JS, Gaujoux-Viala C et al (2012) European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis 71:4–12

    Article  CAS  PubMed  Google Scholar 

  9. Grigor C, Capell H, Stirling A et al (2004) Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 364:263–269

    Article  PubMed  Google Scholar 

  10. Hatz HJ (2005) Glucocorticoide: Immunologische Grundlagen, Pharmakologie und Therapierichtlinien, 2. Aufl. WVG, Stuttgart

  11. Hetland ML, Stengaard-Pedersen K, Junker P et al (2006) Combination treatment with methotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis: an investigator-initiated, multicenter, randomized, double-blind, parallel-group, placebo-controlled study. Arthritis Rheum 54:1401–1409

    Article  CAS  PubMed  Google Scholar 

  12. Hetland ML, Østergaard M, Ejbjerg B et al (2012) Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP. Ann Rheum Dis 71:851–856

    Article  CAS  PubMed  Google Scholar 

  13. Hochberg MC, Altman RD, April KT et al (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip and knee. Arthritis Care Res 64:465–474

    Article  CAS  Google Scholar 

  14. Hollander JL (1953) Intra-articular hydrocortisone in arthritis and allied conditions: a summary of two years‘ clinical experience. J Bone Joint Surg Am 35:983–990

    PubMed  Google Scholar 

  15. Horseless Peterson K, Hetland ML, Junker P et al (2014) Adalimumab added to a treat-to-target strategy with methotrexate and intra-articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA study: an investigator-initiated, randomised, double-blind, parallel-group, placebo-controlled trial. Ann Rheum Dis 73:654–661

    Google Scholar 

  16. http://www.abim.org/certification/policies/imss/rheu.aspx. Zugegriffen: 24. Juni 2015

  17. http://www.aekwl.de/fileadmin/weiterbildung/WO/WO_2014_Sonderdruck_idF__2014-09-20-3.pdf. Zugegriffen: 24. Juni 2015

  18. http://www.eular.org/myUploadData/files/UEMS_Rheumatology_Specialist_Training_Record_2003.pdf. Zugegriffen: 24. Juni 2015

  19. http://dgrh.de/leitliniefruehera.html. Zugegriffen: 24. Juni 2015

  20. http://dgrh.de/qualitaetsmanualhrsg.html. Zugegriffen: 24. Juni 2015

  21. http://www.jrcptb.org.uk/specialties/rheumatology. Zugegriffen: 24. Juni 2015

  22. http://www.rheumatology.org/portals/0/Files/Joint%20Injections.pdf. Zugegriffen: 3. Aug. 2015

  23. Jennings H, Hennessy K, Hendry J (2014) The clinical effectiveness of intraarticular corticosteroids for arthritis of the lower limb in juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol 12:23. http://ped-rheum.com/content/12/1/23

  24. Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (2011) Anforderungen an die Hygiene bei Punktion und Injektion. Bundesgesundheitsblatt 54:1135–1144

    Article  Google Scholar 

  25. Kuusalo L, Puolakka K, Kautiainen H et al (2015) Impact of neglecting intra-articular glucocorticoid-injections in remission targeted treatment of early rheumatoid arthritis. Ann Rheum Dis 74(Suppl. 2):237

  26. Lanni S, Bertamino M, Consolaro A et al (2011) Outcome and predicting factors of single and multiple intra-articular corticosteroid injections in children with juvenile idiopathic arthritis. Rheumatology 50:1627–1634

    Article  CAS  PubMed  Google Scholar 

  27. Leirisalo-Repo M, Kautiainen H, Laasonen L (2013) Infliximab for 6 months added on combination therapy in early rheumatoid arthritis: 2-year results from an investigator-initiated, randomised, double-blind, placebo-controlled study (the NEO-RACo Study). Ann Rheum Dis 72:851–857

    Article  CAS  PubMed  Google Scholar 

  28. Möttönen T, Hannonen P, Leirisalo-Repo M et al (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomized trial. FIN-RACo trial group. Lancet 353:1568–1573

    Article  PubMed  Google Scholar 

  29. Nam JL, Ramiro S, Gaujoux-Viala C et al (2014) Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 73:516–528

    Article  CAS  PubMed  Google Scholar 

  30. Papadopoulou C, Kostik M, Isabel M et al (2013) Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era. Arthritis Care Res 65:1112–1120

    Article  CAS  Google Scholar 

  31. Rantalaiho V, Puolakka K, Korpela M et al (2012) Long-term results of the FIN-RACo trial; treatment with a combination of traditional disease-modifying anti-rheumatic drugs is an excellent option in early rheumatoid arthritis. Clin Exp Rheumatol 30(Suppl 73):S27–S31

    PubMed  Google Scholar 

  32. Ravelli A, Magni Manzoni S, Viola S et al (2001) Factors affecting the efficacy of intraarticular corticosteroid injections of knees in juvenile idiopathic arthritis. J Rheumatol 28:2100–2102

    CAS  PubMed  Google Scholar 

  33. Zhang W, Doherty M, Pascual P et al (2011) EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis 70:571–575

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Hammer, T. Schwarz und G. Ganser geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Rheumatologie, St. Josef-Stift, Westtor 7, 48324, Sendenhorst, Deutschland

    M. Hammer, T. Schwarz & G. Ganser

Authors
  1. M. Hammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Ganser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Hammer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hammer, M., Schwarz, T. & Ganser, G. Intraartikuläre Injektion mit Kortison. Z Rheumatol 74, 774–779 (2015). https://doi.org/10.1007/s00393-015-1626-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-015-1626-x

Schlüsselwörter

Keywords

Search

Navigation