Summary
Intravenous regional administration of corticosteroid (IVRAS) in the treatment of rheumatoid arthritis of the hand has not been reported previously. The method is based on a modification of Bier's block, with substitution of corticosteroid for local anaesthetic. Twenty-two patients were assessed in this double-blind, placebo-controlled study. The technique was safe and effective in improving grip strength, with a group mean improvement of more than 50%. Because suppression of endogenous cortisol production 24 h after treatment was commensurate with the dose of methylprednisolone used (40 mg), we could not exclude that the response may have been due to systemic steroid. Further studies are required to define the real value of IVRAS as it may offer alternative treatment of the joints and tendons within the hand and wrist in some patients rather than more prolonged oral therapy or individual, multiple joint or sheath injections.
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References
Gray RC, Gottlieb NL (1983) Intra-articular corticosteroids: an updated assessment. Clin Orthop 177:235
Axelrod L (1979) In: Miller RR, Greenblatt DJ (eds) Handbook of drug therapy. Elsevier North, New York, p 809
Bier A (1906) Über einen neuen Weg, Lokalanästhesie an den Gliedmaßen zu erzeugen. Arch Klin Chir 86:1007
Ropes MW, Bennet EA, Cobb S, Jacox R, Jessar R (1958) Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis 9:175
Rose JQ, Jusko WJ (1979) Corticosteroid analysis in biological fluids by high performance liquid chromatography. J Chromatogr 162:273
Bywaters EGL, Dixon A St John (1953) Effect of intra-articular injection of cortisone acetate and of hydrocortisone acetate in rheumatoid arthritis. Clin Sci 12:15
Jacobs S, Pullen PT, Potter JM, Shenfield GM (1983) Adrenal suppression following extradural steroids. Anaesthesia 38:953
Esselinckx W, Bacon PA, Ring EFJ, Crooke D, Collins AJ, Demottaz D (1978) A thermographic assessment of three intraarticular prednisolone analogues given in rheumatoid synovitis. Br J Clin Pharmacol 5:447
Potter JM, Langton PE (1987) In vivo and in vitro steroid responsiveness in patients with auto-immune arthritis. Proc 10th Int Cong Pharmacol 524 (abstr)
Armstrong RD, English J, Gibson T, Chakraborty J, Marks V (1981) Serum methylprednisolone levels following intraarticular injection of methylprednisolone acetate. Ann Rheum Dis 40:571
Murdoch WR, Will G (1962) Methylprednisolone acetate in intraarticular therapy. Br Med J 1:604
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Jelinek, G.A., Will, R., Dusci, L.J. et al. Intravenous regional administration of methylprednisolone in rheumatoid arthritis. Rheumatol Int 11, 147–150 (1991). https://doi.org/10.1007/BF00332552
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DOI: https://doi.org/10.1007/BF00332552