Corticosteroid injections

When only one or two joints are affected, intraarticular corticosteroid injection can provide rapid relief with a relatively... 

Monitor patients receiving intraarticular corticosteroid injections for increased swelling or pain at the injection site. 

Intraarticular corticosteroid injections can provide relief, particularly when a joint effusion is present. Average doses for injection of large joints in adults are methylprednisolone acetate 20 to 40 mg or triamcinolone hexacetonide 10 to 20 mg. After aseptic aspiration of the effusion and corticosteroid injection, initial pain relief may occur within 24 to 72 hours, with peak relief occurring in about 1 week and lasting for 4 to 8 weeks. The patient should minimize joint activity and stress on the joint for several days after the injection. Therapy is generally limited to three or four injections per year because of the potential systemic effects of the drugs and because the need for more frequent injections indicates poor response to therapy. 

Management of an acute attack of gout involves the use of high doses of nonsteroidal anti-inflammatory agents (NSAIDs). Colchicine is useful in patients with heart failure where the use of NSAIDs is contraindicated because of water retention. Allopurinol and other uricosuric agents are not indicated for acute attacks as they may aggravate the condition. The use of an intra-articular corticosteroid injection in gout is unlicensed. 

PA is defined when concomitant weekly polyarticular corticosteroids injections together with corticosteroids injections into trigger points of secondary fibromyalgia and inflammation of attachments of skeletal muscles to bone (enthesitis) are administered. 

Baumal CR, Martidis A, Truong SN. Central serous chorioretinopathy associated with periocular corticosteroid injection treatment for HLA-B27-associated iritis. Arch Ophthalmol 2004 122 926-8. 

Spaccarelli KC. Lumbar and caudal epidural corticosteroid injections. Mayo Clin Proc 1996 71(2) 169-78. 

Chen YC, Gajraj NM, Clavo A, Joshi GP. Posterior sub-capsular cataract formation associated with multiple lumbar epidural corticosteroid injections. Anesth Analg 1998 86(5) 1054-5. 

Sandberg DI, Lavyne MH. Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections case report. Neurosurgery 1999 45(l) 162-5. 

Gutierrez-Urena S, Ramos-Remus C. Persistent hiccups associated with intraarticular corticosteroid injection. J Rheumatol 1999 26(3) 760. 

Rimbaud P, Meynadier J, Guilhou JJ, Meynadier J. Complications dermatologiques locales secondaires aux injections cortisonees. [Local dermatological complications secondary to corticosteroid injections.] Nouv Presse Med 1974 3(ll) 665-8. 

Arroll B, Goodyear-Smith F. Corticosteroid injections for painful shoulder a meta-analysis. BrJ Gen Pract. 2005 55 224-228. 

Bell AD, Conaway D. Corticosteroid injections for painful shoulders. IntJ Clin Pract. 2005 59 1178-1186. 

Weijtens O, Vandersluijs FA, Schoemaker RC, et al. Peribulbar corticosteroid injection vitreal and serum concentrations after dexamethasone cUsocUum phosphate injection. Am J Ophthalmol 1997 123 358-363. 

Inflammation is another serious side effect of intravitreal injections of corticosteroids. Pseudoendophthalmitis, sterile endophthalmitis, and infectious endophthalmitis have all been reported after injection. True infectious endophthalmitis tends to present later than pseudoendophthalmitis, usually occurring 1 to 2 weeks after injection. This might be caused by the masking effect of the presence of corticosteroid injected into the eye. Steroid endophthalmitis tends to be self-limiting, and some... 

Hosal BM, ZUelioglu G. Ocular complications of intralesional corticosteroid injection of a chalazion. Eur J Ophthalmol 2003 13 798-799. 

Te use of NSAIDS and other anti-inflammatory therapies are similar to those used in other autoimmune arthritic disorders. Corticosteroid injections for severe pain and inflammation at specific joints are standard therapy. For severe forms of the disease immunomoduladng and-rheumatic drugs such as methodexate and sulfasalazine are effecdve. As with other similar disorders, the biologic TNF a inhibitors are currently prescribed for severe Reiter s synchome. 

Intra-articular injection of corticosteroid (triamcinolone, hydrocortisone, prednisolone or dex-amethasone) is very effective when one joint is more affected than others. Benefit from one injection may last many weeks. Aseptic precautions must be extreme, for any introduced infection may spread dramatically. Too frequent resort to corticosteroid injection may actually promote joint damage by removing the protective limitation conferred by pain such injections in a single joint would not normally exceed three per year. Other aspects of the treatment of inflammatory arthritis are important but are outside the scope of this book. 

Transcutaneous electrical nerve stimulation (TENS) helps some sufferers it may act by promoting the release of endorphins. Ketamine (see p. 353) or lidocaine (Ugnocaine) (by i.v. infusion) are used in special circumstances. Pain due to nerve compression may be reUeved by a corticosteroid injected loccally. 

Pelletier J, Dibattista J A, Raynauld J et al 1995 The in vivo effects of intraarticular corticosteroid injections on cartilage lesions, stromelysin, interleukin-1 and oncogene protein synthesis in experimental osteoarthritis. Laboratory Investigation 72 578-586... 

Viscosupplementation via intra-articular hyaluronic acid injections is a conservative treatment modality to be used in conjunction with other conservative management modalities including activity modification, physical therapy, analgesics, nonsteroidal anti-inflammatories (NSAIDS), and intra-articular corticosteroid injections. It is only approved by the FDA for treating osteoarthritis of the knee. Off-label use has been reported for treatment of osteoarthritis affecting the earpometacarpal joints of the thumb, apophyseal joints of the lumbar spine, hip, ankle, and foot [1, 34, 40, 92, 101]. 

The ability of kidney slices of adrenalectomized animals to generate glucose from pyruvate, succinate, and glutamate is lower than the glucogenic activity of kidney obtained from nonadrenalectomized animals. Corticosteroid injection to adrenalectomized animals before the kidney slices are collected restores glucogenic activities to normal. 

Suspensions are regularly used as a dosage form. Examples can be found in oral suspensions (co-trimoxazol suspension), dermatological preparations (zinc oxide or calamine lotions like Zinc oxide lotion NRF (Table 18.17)), parenteral preparations (corticosteroid injections, medroxyprogesterone injection) and a suspension in the form of a solid dispersed in a melted fat base as in the case of suppositories. 

Treatments. The most common treatment for rheumatologic conditions is medication, which is a critical part of the care of people with rheumatologic diseases. In addition, the rheumatologist uses other treatments such as corticosteroid injections, withdrawal of fluid from joints, physical therapy, occupational therapy, the application of heat or cold, elevation of an extremity, and the application of joint support devices. 

Gruson KI, Ruchelsman DE, Zuckerman JD. Subacromial corticosteroid injections. / Shoulder Elbow Surg 2008 17 118S-130S. 

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