Intra-articular steroid injection

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. 

Clinically, viscosupplementation has been shown to perform better than placebo but comparisons to intra-articular steroid injection are ineonsistent [10]. It has a low complication rate but may incite an inflammatory response in some patients [23, 39, 57]. An independently funded, randomized, controlled trial has... 

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... 

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as a disease-modifying antirheumatic drug and is used as a second-line treatment in rheumatoid arthritis, but has been superseded by methotrexate, administered v/eekly.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

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. 

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. 

Intra-articular corticosteroids may be useful in some patients, particularly if there is an acute flare of the disease. The joint is injected with a steroid and this can reduce inflammation and joint effusion. The joint should not be injected more than once every three months... 

Corticosteroids also may be delivered by injection. The intramuscular route is preferable in patients with compliance problems, since a depot effect is achieved. Depot forms of corticosteroids include triamcinolone acetonide, triamcinolone hexacetonide, and methylprednisolone acetate. This provides the patient with 2 to 8 weeks of symptomatic control. The depot effect provides a physiologic taper, avoiding withdrawal reaction associated with hypothalamic-pituitary axis suppression. It should be noted that the onset of effect via this route may be delayed by several days. Intravenous corticosteroids may be used to provide the patient with large amounts of drug during a steroid burst to control severe symptoms. Intra-articular injections of depot forms of corticosteroids can be useful in treating synovitis and pain when a small number of joints are affected. The onset and duration of symptomatic relief are similar to those of intramuscular injection. The intra-articular route often is preferred because it is associated with the fewest number of systemic adverse effects. If efficacious, intra-articular injections may be repeated every 3 months. No one joint should be injected more than two to three times per year because of the risk of accelerated joint destruction and atrophy of tendons. Soft tissues such as tendons and bursae also may be injected. This may help control the pain and inflammation associated... 

The fall in serum corticosteroid levels is established and of clinical importance in systemic treatment, but it seems unlikely to affect the response to steroids given topically or by inhalation, intra-articular injection or enema. The interaction can be accommodated in several ways ... 

Septic arthritis of the glenohumeral joint has predilection for very young infants or elderly patients with chronic debilitating disorders, such as diabetes, cirrhosis and alcoholism. The intra-articular injection of corticosteroids greatly increases the likelihood of infectious disease because of steroid-induced... 

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