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Intra-articular Corticosteroid Treatment of Inflammatory Joint Diseases

  • Chapter
Local Treatment of Inflammatory Joint Diseases

Abstract

On January 27, 1951, a study group led by Joseph Lee Hollander injected three rheumatoid arthritis patients with the first intra-articular hydrocortisone injections. These three patients showed clinical improvements in local inflammation. This group went on to inject 1,500 test patients with nearly 24,000 injections into the joints, bursae, and tendon sheaths. Fifty percent of these patients experienced clinically significant improvement of local inflammation [1]. Over the last 65 years, corticosteroid injections have become a valuable and efficacious treatment option in the management of inflammatory arthritis with an excellent safety record [2].

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References

  1. Hollander JL. The use of intra-articular hydrocortisone, its analogs, and its higher esters in arthritis. Ann N Y Acad Sci. 1955;61:511–6.

    Article  CAS  PubMed  Google Scholar 

  2. Guidelines, American College of Rheumatology Subcommittee on Rheumatoid Arthritis. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46:328–46.

    Article  Google Scholar 

  3. Cole BJ, Schumacher Jr HR. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13:37–46.

    PubMed  Google Scholar 

  4. Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol. 2010;29:347–56.

    Article  PubMed  Google Scholar 

  5. Cordone DA, Tallia E. Joint and soft tissue injection. Am Fam Physician. 2002;66:283–8.

    Google Scholar 

  6. Derendorf H, et al. Pharmacokinetics and pharmacodynamics of glucocorticoid suspensions after intra-articular administration. Clin Pharmacol Ther. 1986;39:313–7.

    Article  CAS  PubMed  Google Scholar 

  7. Dent PB, Walker N. Intra-articular corticosteroids in the treatment of juvenile rheumatoid arthritis. Curr Opin Rheumatol. 1998;10:475–80.

    Article  CAS  PubMed  Google Scholar 

  8. Saunders S, Longworth S. Injection techniques in musculoskeletal medicine. Edinburg: Churchill Livingstone; 2012.

    Google Scholar 

  9. Schumacher HR, Chen LX. Injectable corticosteroids in treatment of arthritis of the knee. Am J Med. 2005;118:1208–14.

    Article  CAS  PubMed  Google Scholar 

  10. Stephens M, Beutler A, O’Connor F. Musculoskeletal injections: a review of the evidence. Am Fam Physician. 2008;78:971–5.

    PubMed  Google Scholar 

  11. Raynauld JP, Buckland-Wright C, Ward E, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double blind, placebo-controlled trial. Arthritis Rheum. 2003;48:370–7.

    Article  CAS  PubMed  Google Scholar 

  12. Roberts WN, Babcock EA, Breitbach SA, et al. Corticosteroid injection in rheumatoid arthritis does not increase rate of total joint arthroplasty. J Rheumatol. 1996;23:1001–4.

    CAS  PubMed  Google Scholar 

  13. Kumar N, Newman RJ. Complications of intra- and peri-articular steroid injections. Br J Gen Pract. 1999;49:465–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Kahn CB, Hollander JL, Schumacher HR. Corticosteroid crystals in synovial fluid. JAMA. 1970;211:807–9.

    Article  CAS  PubMed  Google Scholar 

  15. Firetein GS, Panayi GS, Wollheim FA. Rheumatoid arthritis frontiers in pathogenesis and treatment. Oxford: Oxford University Press; 2000. p. 361–9.

    Google Scholar 

  16. Cassidy JT, Bole GG. Cutaneous atrophy secondary to intra-articular glucocorticoid administration. Ann Intern Med. 1966;65:1008–18.

    Article  CAS  PubMed  Google Scholar 

  17. Gilsanz V, Bernstein BH. Joint calcification following intra-articular corticosteroid therapy. Radiology. 1984;151:647–9.

    Article  CAS  PubMed  Google Scholar 

  18. Blanco I, Krahenbuhl S, Schlienger RG. Corticosteroid-associated tendinopathies: an analysis of the published literature and spontaneous pharmacovigilance data. Drug Saf. 2005;28:633–43.

    Article  CAS  PubMed  Google Scholar 

  19. Pal B, Morris J. The perceived risks of joint injection following intra-articular corticosteroid injections: a survey of rheumatologists. Clin Rheumatol. 1999;18:264–5.

    Article  CAS  PubMed  Google Scholar 

  20. Charalambous CP, Tryfonidis S, Sadiq P, et al. Septic arthritis following intra-articular steroid injection of the knee: a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol. 2003;22:386–90.

    Article  CAS  PubMed  Google Scholar 

  21. Lazarevic MB, Skosey JL, Djordjevic-Denic G, et al. Reduction of cortisol levels after single-intra-articular and intramuscular steroid injection. Am J Med. 1995;99:370–3.

    Article  CAS  PubMed  Google Scholar 

  22. Godwin M, Dawes M. Intra-articular steroid injections for painful knees: systematic review with meta-analysis. Can Fam Physician. 2004;50:241–8.

    PubMed  PubMed Central  Google Scholar 

  23. Slotkoff AT, Clauw DJ, Nashel DJ. Effect of soft tissue corticosteroid injection on glucose control in diabetics. Arthritis Rheum. 1994;37:S347 (abstract).

    Google Scholar 

  24. Nesbitt LT. Minimizing complications from systemic glucocorticosteroid use. Clin Dermatol. 1995;13:925–39.

    Google Scholar 

  25. Gensler L. Glucocorticoids: complications to anticipate and prevent. Neurohospitalist. 2012;3:92–7.

    Article  Google Scholar 

  26. Emkey RD, Lindsay R, Lissy J, et al. The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone formation and bone resorption in patients with rheumatoid arthritis. Arthritis Rheum. 1996;39:277–82.

    Article  CAS  PubMed  Google Scholar 

  27. Moreland L, O’Dell J. Glucocorticoids in rheumatoid arthritis. Arthritis Rheum. 2002;46:2553–63.

    Article  CAS  PubMed  Google Scholar 

  28. afKlint E, Grundman C, Engström M, et al. Intra-articular glucocorticoid treatment reduces inflammation in synovial cell infiltrations more efficiently than in synovial cell infiltrations more efficiently than in synovial blood vessels. Arthritis Rheum. 2005;52:3880–9.

    Article  CAS  Google Scholar 

  29. Neeli I, Khan SN, Radic M. Histone deimination as a response to inflammatory stimuli in neutrophils. J Immunol. 2008;180:1895–902.

    Article  CAS  PubMed  Google Scholar 

  30. Makrygiannakis D, Revu S, Engström M, et al. Local administration of glucocorticoids decreases synovial citrullination in rheumatoid arthritis. Arthritis Res Ther. 2012;14:1–9.

    Article  Google Scholar 

  31. Chatham W, Williams G, Moreland L, et al. Intraarticular corticosteroid injections: should we rest the joints? Arthritis Care Res. 1989;2:70–4.

    Article  CAS  PubMed  Google Scholar 

  32. Boesen M, Boesen L, Jensen KE, et al. Clinical outcome and imaging changes after intraarticular (IA) application of etanercept or methylprednisolone in rheumatoid arthritis: magnetic resonance imaging and ultrasound-Doppler show no effect on IA injections in the wrist after 4 weeks. J Rheumatol. 2008;35:584–91.

    CAS  PubMed  Google Scholar 

  33. Hertzberger-Ten RC, deVries-van der Vluge BLM, et al. Intra-articular steroids in pauciarticular juvenile chronic arthritis, type 1. Eur J Pediatr. 1991;150:170–2.

    Article  Google Scholar 

  34. Bloom B, Alaria A, Miller L. Intra-articular corticosteroid therapy for juvenile idiopathic arthritis: report of an experiential cohort and literature review. Rheumatol Int. 2011;31:749–56.

    Article  CAS  PubMed  Google Scholar 

  35. Beukelman T, Guevara JP, Albert DA. Optimal treatment of knee monoarthritis in juvenile idiopathic arthritis: a decision analysis. Arthritis Rheum. 2008;59:1580–8.

    Article  PubMed  Google Scholar 

  36. Lepore L, del Santo M, Malargio C, et al. Treatment of juvenile idiopathic arthritis with intra-articular triamcinolone hexacetonide: evaluation of clinical effectiveness correlated with ANA and T gamma/delta+ and B CD5+ lymphocyte populations of synovial fluid. Clin Exp Rheumatol. 2002;20:719–22.

    CAS  PubMed  Google Scholar 

  37. Huppertz HI, Tschammler A, Horwitz AE, et al. Intraarticular corticosteroids for chronic arthritis in children: efficacy and effects on cartilage and growth. J Pediatr. 1995;127:317–21.

    Article  CAS  PubMed  Google Scholar 

  38. Zulian F, Martini G, Gobber D, et al. Triamcinolone acetonide and hexacetonide intraarticular treatment of symmetrical joints in juvenile idiopathic arthritis: a double blind trial. Rheumatology (Oxford). 2004;43:1288–91.

    Article  CAS  PubMed  Google Scholar 

  39. Gran JT, Husby G. Ankylosing spondylitis. Current drug treatment. Drugs. 1992;44:585–603.

    Article  CAS  PubMed  Google Scholar 

  40. Gunaydin I, Pereira PL, Fritz J, et al. Magnetic resonance imaging guided corticosteroid injection of sacroiliac joints in patients with spondylarthropathy. Are multiple injections more beneficial? Rheumatol Int. 2006;26:396–400.

    Article  CAS  PubMed  Google Scholar 

  41. Braun J, van den Berg R, Baraliokos X, et al. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and follow up by dynamic magnetic resonance imaging. J Rheumatol. 1996;23:659–64.

    CAS  PubMed  Google Scholar 

  42. Spies CM, Burmester GR, Buttgereit F. Analysis of similarities and differences in glucocorticoid therapy between rheumatoid arthritis and ankylosing spondylitis – a systemic comparison. Clin Exp Rheumat. 2009;27 Suppl 55:S152–8.

    CAS  Google Scholar 

  43. Wechalekar M, Vinik O, Schlesinger M, et al. Intra-articular glucocorticoids for acute gout. Cochrane Database Syst Rev. 2013;(4):1–16.

    Google Scholar 

  44. Richette P, Pardin T. Gout. Lancet. 2010;375(9711):318–28.

    Google Scholar 

  45. Koski JM. Ultrasound guided injection in rheumatology. J Rheumatol. 2000;27:2131–8.

    CAS  PubMed  Google Scholar 

  46. Balint PV, Kane D, Hunter J, et al. Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J Rheumatol. 2002;29:2209–13.

    PubMed  Google Scholar 

  47. Sibbitt WL, Peisajovich A, Michael AA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol. 2009;36:1892–902.

    Article  PubMed  Google Scholar 

  48. Raza K, Lee CY, Pilling D, et al. Ultrasound guidance allows accurate needle placement and aspiration from small joints in patients with early inflammatory arthritis. Rheumatology. 2003;42:976–9.

    Article  CAS  PubMed  Google Scholar 

  49. Brostrom E, Hagelber S, Haglund-Akerlind Y. Effect of joint injections in children with juvenile idiopathic arthritis: evaluation by 3D-gait analysis. Acta Paediatr. 2004;93:906–10.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jess D. Edison .

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Tracy, C.L., Edison, J.D. (2015). Intra-articular Corticosteroid Treatment of Inflammatory Joint Diseases. In: Kampen, W., Fischer, M. (eds) Local Treatment of Inflammatory Joint Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-16949-1_3

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  • DOI: https://doi.org/10.1007/978-3-319-16949-1_3

  • Publisher Name: Springer, Cham

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