Intra-articular injections

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. 

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

Gelatin 0.301 Intra-articular injection Triamcinolone diacctate... 

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as a disease-modifying antirheumatic drug and is used as a second-line treatment in rheumatoid arthritis, but has been superseded by methotrexate, administered v/eekly.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. 

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. 

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. 

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. 

Corticosteroids are sometimes used in the treatment of severe symptomatic gout, by intra-articular, systemic, or subcutaneous routes, depending on the degree of pain and inflammation. The most commonly used oral corticosteroid is prednisone. The recommended dose is 30-50 mg/d for 1-2 days, tapered over 7-10 days. Intra-articular injection of 10 mg (small joints), 30 mg (wrist, ankle, elbow), and 40 mg (knee) of triamcinolone acetonide can be given if the patient is unable to take oral medications. 

Local therapy, such as topical preparations for skin disease, ophthalmic forms for eye disease, intra-articular injections for joint disease, inhaled steroids for asthma, and hydrocortisone enemas for ulcerative colitis, provides a means of delivering large amounts of steroid to the diseased tissue with reduced systemic effects. 

Parenteral 4 mg/mLfor IV, IM, intralesional, or intra-articular injection Cortisone (generic, Cortone Acetate)... 

Parenteral 25, 50 mg/mL suspension for intralesional, soft tissue, or intra-articular injection Hydrocortisone cypionate (Cortef)... 

Intra-articular injections of orgotein proved effective in degenerative joint disease The side effects of radiation therapy in patients with bladder tumors were also reduced by the administration of SOD The nephrotoxicity of cw-diamine-dichloroplatinum in rats was similarly lowered by the subcutaneous administration of (Cu,Zn)-SOD... 

A 42-year-old woman developed a nonpigmented fixed drug eruption after skin testing and an intra-articular injection of triamcinolone acetonide, which has not been previously reported (178). 

Tendons can be injured by glucocorticoids and can rupture (276). Ten cases of Achilles tendon rupture were seen in a single clinic over a 10-year period (SEDA-17, 448). The risk seems to be greater if local (for example intra-articular) injections are used. 

A 38-year-old man had an intra-articular injection of betamethasone dipropionate (dose not stated) into his right ankle, and the day after had hiccups that lasted for 24 hours and then resolved without treatment. Some months later, because of persistent arthritis, he received a further injection of betamethasone dipropionate into his right ankle. Once again, he had hiccups the following day. On this occasion, the hiccups resolved after 2 weeks, following treatment with levo-mepromazine. 

A 65-year-old man with bilateral osteoarthritis of the knees developed an effusion in the left knee. The swollen joint was treated with an intra-articular injection of triamcinolone hexacetonide 40 mg. The next day, he developed acute arthritis in the injected knee the joint was swollen and tender and he was unable to walk. Examination of the joint fluid showed 35 ml of a thick, turbid, yellowish synovial fluid with a leukocyte count of 13 x 106/1 (95% neutrophils). Gram and acridine orange stains were negative. Wet preparations of... 

Bioulac P, Beylot C. Etude ultrastructurale d une leuco-dermie secondaire a une injection intraarticulaire de corti-coides. [Ultrastructural study of a leukoderma secondary to an intra-articular injection of corticoides.] Ann Dermatol Venereol 1977 104(12) 883-5. 

Ozanguc N. Nonpigmenting solitary fixed drug eruption after skin testing and intra-articular injection of triamcino- 195. lone acetonide. Ann Allergy Asthma Immunol... 

Drugs are applied to the mucous membranes of the conjunctiva, nasopharynx, and vagina to achieve local effects. On the other hand, the antidiuretic hormone lypressin (Diapid) is given by nasal spray, but the intention is to produce systemic effects. For the treatment of meningeal leukemia, cytosine arabinoside is injected directly into the spinal subarachnoid space. In osteoarthritis, corticosteroids are given by intra-articular injection. 

The use of steroids is an alternative to NSAIDs or colchicine. If the gout is only affecting one or two joints then an intra-articular injection may be given (unlicensed indication). A differential diagnosis between septic arthritis and acute gout must be certain because intra-articular steroids will exacerbate an... 

Bacterial infections elicit a series of acute-phase responses which include central nervous system effects such as changes in body temperature and increased slow-wave sleep. Dead bacteria [54] and murein preparations [55] as well as other bacterial cell-wall products induce similar responses. Intravenous injections of rabbits with suspensions of pseudomurein from Methanobacterium thermoautotrophicum also alter sleep and brain temperature. The mechanisms responsible for these somnogenic and pyrogenic effects are unknown [56]. It has been demonstrated that in a rat arthritis model, intra-articular injection of high doses of pseudomurein-polysaccharide fragments from Methanobacterium formicicum caused an acute inflammation [57]. 

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. 

These consist largely of too intense production of the physiological or pharmacological actions listed under actions of hydrocortisone. Some occur only with systemic use and for this reason local therapy, e.g. inhalation, intra-articular injection, is preferred where practicable. 

Seven cases of gaseous edema were observed in the former German Democratic Republic (GDR) after intramuscular injections following rubbing of the skin with ethanol (SEDA-11,474) this led to a national recommendation that alcohols should not be used to cleanse the skin before intramuscular injection, injection of vasoconstrictors, injections in patients with disturbed peripheral circulation, or before lumbar, paraneural, or intra-articular injection and puncture (SEDA-11, 474) (1). 

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