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BioDrugs

, Volume 9, Issue 2, pp 95–103 | Cite as

Intra-Articular Corticosteroids in Arthritic Disease

A Guide to Treatment
  • Mikkel Østergaard
  • Poul Halberg
Disease Management

Summary

Intra-articular corticosteroid injections are widely used in aseptic arthritis, most often as a supplement to systemic anti-inflammatory therapy. Suppression of local joint inflammation by corticosteroids is rapid and pronounced, and may be achieved with only minor systemic effects; however, this suppression is usually only temporary. The original compound hydrocortisone acetate has been replaced by longer-acting preparations such as methylprednisolone acetate, tri-amcinolone acetonide and triamcinolone hexacetonide. In controlled studies, triamcinolone hexacetonide has proved most effective, providing clinical effect for a mean period up to several months. However, this compound frequently causes local tissue necrosis when injected outside a synovial cavity, and it should be used only by experienced clinicians.

Indications for intra-articular corticosteroids include mono- or oligoarthritis in rheumatoid arthritis and other aseptic inflammatory joint diseases. Intra-articular corticosteroids are also used in osteoarthritis, but in controlled studies the effect is brief and transient.

A number of potential adverse effects of intra-articular corticosteroids stress the importance of their judicious use. The risk of cartilage damage and progressive joint destruction is a controversial issue. The results of animal studies are ambiguous. Despite case reports of severe arthropathy, most studies on humans suggest that, when used appropriately, the beneficial effects of intra-articular corticosteroids exceed the harmful effects. Nevertheless, it is recommended that corticosteroid injections into the same joint should be limited, for instance to 1 injection every 6 weeks and no more than 3 to 4 in 1 year. Prior to intra-articular corticosteroid injections the indications and contraindications should always be considered. In particular, infection should be ruled out. Strict aseptic technique is essential to avoid iatrogenic septic arthritis.

Correct intra-articular corticosteroid therapy is of great clinical value in the management of aseptic arthritic disease.

Keywords

Rheumatol Triamcinolone Acetonide Tiaprofenic Acid Arthroscopic Synovectomy Triamcinolone Hexacetonide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Mikkel Østergaard
    • 1
  • Poul Halberg
    • 1
  1. 1.Department of RheumatologyHvidovre HospitalHvidovreDenmark

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