Intra-articular

Parenteral drug administration means the giving of a drug by the subcutaneous (SC), intramuscular (IM), intravenous (IV), or intradermal route (Fig. 2-5). Other routes of parenteral administration that may be used by the primary care provider are intralesional (into a lesion), intra-arterial (into an artery), intracardiac (into the heart), and intra-articular (into a joint), hi some instances, intra-arterial dragp are administered by a nurse. However, administration is not by direct arterial injection but by means of a catheter that has been placed in an artery. 

The primary care provider may administer a drug by the intracardial, intralesional, intra-arterial, or intra-articular routes. The nurse may be responsible for preparing the drug for administration. The nurse should ask the primary care provider what special materials will be required for administration. 

Promoting an Optimal Response to Therapy The glucocorticoids may be administered orally, IM, SC, IV, topically, or as an inhalant. The primary health care provider may also inject the drag into a joint (intra-articular), a lesion (intralesional), soft tissue, or bursa The dosage of the drug is individualized and based on the severity of the condition and the patient s response. 

This first strategy was used by Setton and coworkers to trigger the in situ formation of an ELP-based dmg depot for sustained release. Biodistribution studies of radiolabeled LLPs with a below body temperature were performed after intra-articular injection in rats [94]. Later, dmg depots of ELPs with covalently attached immunomodulator therapeutics [95] and anti-TNLa therapeutics [96] were created. Respectively, ELP[V-120] and ELP[V-60] biopolymers with a transition below body temperature were used in these studies. 

Jason, M.I.V. and Dixon, A. St. J. (1970a). Intra-articular pressures in rheumatoid arthritis of the knee. I. Pressure changes during passive joint distention. Ann. Rheum. Dis. 29, 261-265. 

Unsworth, J., Outhwaithe, J., Blake, D.R., Morris, C.J., Freeman, J. and Lunec, J. (1988). Dynamic studies of the relationship between intra-articular pressure, synovial fluid oxygen tension, and lipid peroxidation in the inflamed knee an example of reperfusion injury. Ann. Clin. Biochem. 25, 8S-11S. 

Intra-articular In the hollow space within joints. 

Ferromagnetic 0.213 Blood glucose regulators after intra-articular injection Insulin, triamcinolone diacetate... 

Gelatin 0.301 Intra-articular injection Triamcinolone diacctate... 

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. 

The first-line agents in the treatment of rheumatoid arthritis are non-steroidal anti-inflammatory drugs such as diclofenac. Diclofenac and indometacin, another NSAID, tend to have similar activity hov/ever, indometacin has a higher incidence of side-effects and therefore diclofenac is more appropriate for initial treatment. Sodium aurothiomalate is classified as a disease-modifying antirheumatic drug and is used as a second-line treatment in rheumatoid arthritis, but has been superseded by methotrexate, administered v/eekly. Paracetamol is often indicated in the management of osteoarthritis. Local intra-articular injections of dexamethasone may be administered for the relief of soft-tissue inflammatory conditions. 

The IM and SC routes are by far the most frequently used extravascular parenteral routes of drug administration in farm animals. The less frequently used parenteral routes have limited application, in that they aim at directly placing high concentrations of antimicrobial agent close to the site of infection. These routes of administration include intra-articular or subconjuctival injection and intra-mammary or intra-uterine infusion. These local routes differ from the major parenteral routes in that absorption into the systemic circulation is not a prerequisite for delivery of drug to the site of action. The combined use of systemic and local delivery of drug to the site of infection represents the optimum approach to... 

The degree of study subject tolerability to a drug should be assessed in conjimction with the laboratory safety and efficacy data, so that an overall risk to benefit assessment can be made. Poorly tolerated drugs, however efficacious for use in self-limiting non-serious diseases, are unlikely to become successful medicines. On the other hand, study subjects with serious illnesses, such as active rheumatoid arthritis, are frequently quite prepared to put up with poorly tolerated drugs (e.g. intramuscular gold injections or intra-articular steroid injections) if efficacy is good and the alternatives are no more attractive. 

Intra-articular injection Dose depends on the joint size and varies with the severity of the condition. In chronic cases, injections may be repeated at intervals of at least 1 to 5 weeks depending upon the degree of relief obtained from the initial injection. Injection must be made into the synovial space. 

Hydrocortisone acetate - For intralesional, intra-articular, or soft tissue injection only. Not for IV use. Dosage range is 5 to 37.5 mg. If desired, a local anesthetic may be injected before hydrocortisone acetate or mixed in a syringe and given simultaneously. 

Intralesional, intra-articular, or soft tissue injection 4 mg, up to 100 mg. 

Intra-articular, intralesional, or soft tissue administration 8 to 30 mg. Doses greater than 40 mg are not recommended. 

Intra-articular or Intrabursal administration and for injection into tendon sheaths ... 

Locai injections Intra-articular injection may produce systemic and local effects. A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise is suggestive of septic arthritis. Frequent intra-articular injection may damage joint tissues. 

Rheumatic Dz Adults. Intra-articular Hydrocortisone acetate 25-37.5 mg large joint, 10-25 mg small joint methylprednisolone acetate 20-80 mg large joint, 4-10 mg small joint. Intrabursal Hydrocortisone acetate 25-37.5 mg. Intraganglial Hydrocortisone acetate 25-37.5 mg. Tendon sheath Hydrocortisone acetate 5-12.5 mg. 

The mineralocorticosteroid activity of methyl-prednisolone is even less than that of prednisone/ prednisolone. It has a comparable duration of action. It is less suitable for substitution therapy in patients with adrenal hypofunctional states. Methyl-prednisolone sodium succinate is formulated for parental administration while methylprednisolone acetate is used for intra-articularly or peri-articularly injections. It can also be administered IM and then has prolonged systemic effects, lasting 1 weeks as the acetate is absorbed slowly from the site of injection. Oral absorption is rapid with peak effects within 1-2 hours. The duration of action is then about 1.5 days. 

Betamethasone is hardly ever used orally. It has a long duration of activity and can therefore also be used for alternate-day therapy. The parenteral formulation is also the sodium phosphate salt which when given IV or IM has a rapid onset of action. There are many similarities with dexamethasone such as their metabolic pathways and the indications for which both steroids are used, like the prevention of neonatal RDS and reduction of raised intracranial pressure. Combinations of betamethasone acetate and sodium phosphate have, when used for intra-articular and intra-lesional injections, the dual advantage of a rapid onset of action together with the long duration of action of a depot preparation. 

Triamcinolone acetonide and hexacetonide are mainly used for intra-articular, intra-bursal and intra-synovial injection for rheumatological indications. Triamcinolone acetate has a prolonged systemic effect when given intramuscularly. 

Short-term use of corticosteroids such as prednisone or predisolone is indicated for relapses and for intra-articular administration. Symptomatic improvement is rapidly obtained but any progression of the destruction of bone and cartilage is not influenced by corticosteroids. 

NS AIDS were never able to stop the different processes of inflammation, degradation, and reparation of OA. Intra-articular injection of hyaluronic acid has also not been able to stop the destruction of affected joint cartilage over time. The National Institute of Health (USA) has showed that glucosamine or chondroitin sulfate have comparative efficacy with placebo. 

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