Efficacy and safety of intra-articular injection of depot corticosteroids in rheumatic diseases


Authors: R. Svobodová
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 23, 2015, No. 1, p. 22-32.
Category: Rewiev

Overview

Glucocorticoids play a very important role in the ­treatment of rheumatic diseases. In order to control the disease activity it is sometimes necessary to use relatively high doses of systemically administered glucocorticoids, which are associated with a number of serious side effects. Intra-articular or peri-articular steroid injections help manage pain and inflammatory conditions in a short time, minimizing these side effects. This work provides a summary of available intra-articular glucocorticoids and the comparison of their pharmacokinetics, pharmacodynamics, efficacy and safety in various rheumatic diseases and introduces triamcinolone hexacetonide, a synthetic glucocorticoid with a prominent anti-inflammatory and depot effect.

Key words:
Glucocorticoids, intra-articular, triamcinolone hexacetonide, rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis


Sources

1. Habib GS et al. Systemic effects of intra–artricular corticosteroids. Clin Rheumatol 2009; 28: 749–56.

2. Hollander JL, Brown EM, Jessar RA et al. Hydrocortisone and cortisone injected into arthritis joint: comparative effects and use of hydrocortisone as a local antiarthritis agent. JAMA 1951; 147: 16329–35.

3. Schwartz S. Intra-articular administration of triamcinolone acetonide: a preliminary report. N Y State J Med 1960; 60: 3422–5.

4. Kendall PH. Triamcinolone hexacetonide. A new corticosteroid for intra-articular therapy. Ann Phys Med 1967; 9: 55–8.

5. Norcross BM, Winter JA. Methylprednisolone acetate: a single preparation suitable for both intra–articular and systemic use. N Y State J Med 1961; 61: 552–61.

6. Roberts HJ. Local injection of a preparation containing two betamethasone esters in the treatment of noninfectious musculoskeletal disorders. J Am Geriatr Soc 1965; 13: 275–91.

7. Möllmann HW, Armbruster B, Barth J et al. Analysis of shape, grain size distribution and aggregation of crystals in glucocorticoid-depot preparations. Analyse von Form, Korngrößenverteilung und Aggregation der Kristalle in Glukokortikoid-Depotpräparaten. Akt Rheumatol 1990; 15(3): 101–24.

8. Rohdewald P, Möllmann HW, Hochhaus G. Rezeptoraffinitäten handelsüblicher Glukokortikoide zum Glukokortikoid–Rezeptor der menschlichen Lunge. Atemw.-Lungenkrkh 1984; 10 (9); 484–89.

9. Hochhaus G, Möllmann H, Barth J. Glukokortikoide für den intraartikulären Einsatz: Pharmakodynamische Charakterisierung durch Rezeptorbindungsstudien. Akt Rheumatol 1990; 15; 66–69.

10. Armstrong RD, English J, Gibsn T et al. Serum methylprednisolone levels following intra–articular injection of methylprednisolone acetate. Ann Rheum Dis 1981; 40: 571–4.

11. Bertouch JV, Sallustio BC, Mefflin BJ et al. A comparison of plasma methylprednisolone concentrations following intraarticular injection in patients with rheumatoid arthritis and osteoarthritis. Aust N Z Med 1983; 13: 583–5.

12. Weitof T, Ronnblom L. Glucocorticoid resorption and influence on the hypothalamic-pituitary-adrenal axis after intra-articular treatment of the knee in resting and mobile patients. Ann Rheumatol Dis 2006; 65: 955–7.

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

14. Younes M, Neffati F, Touzi M et al. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non–diabetic patients. Joint Bone Spine 2007; 74: 472–6.

15. Hatz H. Lokale intraartikuläre Diagnostik und Therapie – Synovia-Analyse und Injektionstechniken der Gelenke Gebundene Ausgabe – August 2009.

16. Emkey RD, Lindsay R, Lyssy J et al. The systemic effect of intra-articular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis. Arthritis Rheum 1996; 39(2): 277–82.

17. Pavelka K, Vencovský J. Doporučení České revmatologické společnosti pro léčbu revmatoidní artritidy. Čes Revmatol 2010; 18 (4): 182–91.

18. Smolen JS, Landewé R, Breedveld FC et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease–modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014; 73: 492–509.

19. Konai MS, Vilar Furtado RN, Dos Santos MF et al. Monoartricular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind controlled study. Clin Exp Rheumatol 2009; 27(2): 214–21.

20. Furtado R et al. Polyartricular corticosteroid injection versus systemic administration in treatment of rheumatoid arthritis patients: a randomized controlled study. J Rheumatol 2005; 32: 1691–8.

21. Bird HA, Ring EFJ, Bacon PA. Termographic and clinical comparison of 3 intra-articular steroid preparation in rheumatoid arthritis. Ann Rheum Dis 1979; 38(1): 36–9.

22. Blyth T, Stirling A, Coote J et al. Injection of the rheumatoid knee does intra-articular methotrexate or rifampicin add to the benefits of triamcinolone hexacetonide. Br J Rheumatol 1998; 37(7): 770–2.

23. Axelsen MB, Eshed I, Horslev-Petersen K et al. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis: results from the OPERA randomized controlled trial. Ann Rheum Dis 2014; doi:10.1136/annrheumdis–2013–204537.

24. Weitoft T, Rönnelid J, Knight A et al. Outcome predictors of intra-articular glucocorticoid treatment for knee synovitis in patients with rheumatoid arthritis – a prospective cohort study. Arthritis Res Ther 2014; 16: R129

25. Zhang W, Moskowitz RW, Nuki G et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part bII. OARSI evidence based, expert consensus guidelines. Osteoarthr Cartil 2008; 16: 137–62.

26. Bellamy N, Campbell J, Welch V et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee (Review). The Cochrane Collaboration 2009.

27. Cheng OT et al. Evidence based knee injections for the management of arthritis. Pain Med 2012; 13(6): 740–53.

28. Acebes JC, Sanchez–Pernaute O, Diaz–Oca A et al. Ultrasonographic assessment of Baker´s cysts after intra-articular corticosteroid injection in knee osteoarthritis. J Clin Ultrasound 2006; 34(3): 113–7.

29. Gaffney K, Ledingham J, Perry JD. Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response. Ann Rheum Dis 1995; 54(5): 378–81.

30. Pyne D, Ioannou Y, Mootoo R et al. Intra–articular steroids in knee osteoarthritis. A comparative study of triamcinolone hexacetonide and methylprednisolone acetate. Clin Rheumatol 2004; 23(2): 116–20.

31. Meenagh GK, Patton J, Kynes C et al. A randomized controlled trial of intra–articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis. Ann Rheum Dis 2004; 63(10): 1260–3.

32. Pavelka K. Doporučení České revmatologické společnosti pro léčbu osteoartrózy kolenních, kyčelních a ručních kloubů. Čes. Revmatol 2012; 20 (3): 138–57.

33. Hochberg MC, Altman RD, April KT et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64(4): 465–74.

34. Zulian F, Martini G, Gobber D et al. Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. Rheumatology 2004; 43(10): 1288–91.

35. Eberhard BA, Sison MC, Gottleib BS et al. Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis. J Rheumatol 2004; 31(12): 2507–12.

36. Zulian F, Martini G, Gobber D et al. Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2003; 42(10): 1254–9.

37. Balogh Z, Ruzsonyi E. Triamcinolone hexacetonide versus betamethazone. A double-blind comparative study of the long-term effects of intra-articular steroids in patients with juvenile chronic arthritis. Scand J Rheumatol 1988; 67: 80–2.

38. Honkanen VEA, Rautonen JK, Pelkonen PM. Intra-articular glucocorticoids in early juvenile chronic arthritis. Acta Paediatr 1993; 82(12): 1072–4.

39. Bloom BJ, Alario AJ, Miller LC. Intra-articular corticosteroid therapy for juvenile idiopathic arthritis: report of an experimental cohort and literature review. Rheumatol Int 2011; 31: 749–56.

40. Lanni S, Bertamino M, Consolaro A et al. Outcome and predicting factors of single and multiple intra-articular corticosteroid injections in children with juvenile idiopathic arthritis. Rheumatology 2011; 50: 1627–34.

41. Stoll ML, Good J, Sharpe T et al. Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis. J Oral Maxillofac Surg 2012; 70(8): 1802–7.

42. Cahill AM, Cho SS, Baskin KM et al. Benefit of fluoroscopically guided intra-articular long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis. Pediatr Radiol 2007; 37(6): 544–8.

43. Sherry DD, Stein LD, Reed AM et al. Prevention of leg lenght discrepancy in young children with panciarticular juvenile rheumatoid arthritis by treatment with intraarticular steroids. Arthritis Rheum 1999; 42: 2330–4.

44. Ringold S, Weiss PF, Beukelman T et al. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis Rheum 2013; 65(10): 2499–512.

45. Blyth T, Hunter JA, Stirling A. Pain relief in the rheumatoid knee after steroid injection. A single-blind comparison of hydrocortisone succinate, and triamcinolone acetonide or hexacetonide. Br J Rheumatol 1994; 33(5): 461–3.

46. Gray RG, Tenenbaum J, Gottlieb NL. Local corticosteroid treatment in rheumatic disorders. Semin Arthritis Rheum 1981; 10: 231–54.

47. Pavelka K. Doporučení České revmatologické společnosti pro léčbu dnavé artritidy. Čes. Revmatol 2012; 20: 82–92.

48. Sivera F, Andrés M, Carmona L et al. Multinational evidence–based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. Ann Rheum Dis 2013;0:1–8.

49. Pavelka K. Doporučení České revmatologické společnosti pro léčbu ankylozující spondylitidy. Čes. Revmatol 2012; 20(1): 4–11.

50. Braun J, Berg R, Baraliakos X et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896–904.

51. Maugars Y, Mathis C, Vilon P et al. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 1992; 35: 564–8.

52. Braun J, Bollow M, Seyrekbasan F et al. Computed tomography guided corticosteroid injection of the sacroiliac joint in patient with spondylarthropathy with sacroiliitis: clinical outcome and follow-up by dynamic magnetic resonance imaging. J Rheumatol 1996; 23: 659–64.

53. Bollow M, Braun J, Taupitz M et al. CT–guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondylarthropathy: indication and follow-up with contrast enhanced MRI. J Comput Assist Tomogr 1996; 20: 512–21.

54. Maugars Y, Mathis C, Berthelot J–M et al. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double–blind study. Br J Rheumatol 1996; 35: 767–70.

55. Hanly JG, Mitchell M, MacMillan L et al. Efficacy of sacroiliac corticosteroid injections in patients with inflammatory spondylarthropathy: results of a 6 month controlled study. J Rheumatol 2000; 27: 719–22.

56. Štolfa J, Vencovský J, Pavelka K. Doporučené postupy České revmatologické společnosti pro léčbu psoriatické artritidy Čes. Revmatol 2012; 20 (1):13–18.

57. Gossec L, Smolen JS, Gaujoux–Viala C. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis 2012;71:4–12.

58. Gaujoux–Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis. A metaanalysis of randomized control trials. Ann Rheum Dis 2009; 68:1843–9.

59. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003;(1).

60. Green S, Buchbinder R, Glazier R et al. Systematic review of randomized controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998; 316: 354–60.

61. Raynauld JP, Buckland–Wright C, Ward R 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.

62. Gottlieb NL, Penneys NS, Brown Jr HE. Periarticular perilymphatic skin atrophy after intra-articular corticosteroid injections. JAMA 1978; 240: 559–60.

63. Pattrick M, Doherty M. Facial flushing after intra-articular injection of steroid. BMJ 1987; 295(6610): 1380.

64. Job–Deslandre C, Menkes CJ. Complication of intra–articular injections of triamcinolone hexacetonide in chronic arthritis in children. Clin Exp Rheumatol 1990; 8(4): 413–6.

65. Sparling M, Malleson P, Wood B et al. Radiographic follow-up of joints injected with triamcinolone hexacetonide for the management of childhood arthritis. Arthritis Rheum 1990; 33(6): 821–6.

66. Breit W, Frosch M, Meyer U et al. A subgroup–specific evaluation of the efficacy of intra–articular triamcinolone hexacetonide in juvenile chronic arthritis. J Rheumatol 2000; 27(11): 2696–702.

67. Laroche M, Arlet J, Mazieres B. Osteonecrosis of the femoral and humeral heads after intra-articular corticosteroid injections. J Rheumatol 1990; 17: 549–51.

68. Holland C, Jaeger L, Smentkowski U et al. Septic and aseptic complications of corticosteroid injections. Dtsch Arztebl Int 2012; 109(24): 425–30.

69. Seror P, Pluvinage P, d´Andre FL et al. Frequency of sepsis after local corticosteroid injection (an inquiry on 1160000 injections in rheumatological private practice in France). Rheumatology 1999; 38(12): 1272–4.

70. Larson LG. Anaphylactic shock after IA administration of triamcinolone acetonide in a 35–year–old female. Scan J Rheumatol 1989; 18(6): 441–2.

71. Karh J, Yang WH. An anaphylactic reaction to intra-articular triamcinolone a case report and review of the literature. Ann Allergy Asthma Immunol 2003;90(2):254–8.

72. Melby JC. Systemic corticosteroid therapy: pharmacology and endocrinologic considerations. Ann Intern Med 1974; 81(4): 505–12.

73. Alex P, Szodoray P, Arthur E et al. Influence of intra-articular corticosteroid administration on serum cytokines in rheumatoid arthritis. Clin Rheum 2007; 26(5): 845–8.

74. Makrygiannakis D, Revu S, Engstrom M et al. Local administration of glucocorticoid decreases synovial citrullination in rheumatoid arthritis. Arthritis Res Ther 2012; 14(1): R20

75. af Klint E, Grundtman C, Engstrom M et al. Intra-articular glucocorticoid treatment reduces inflammation in synovial cell infiltrations more efficiently than in synovial blood vessels. Arthritis Rheum 2005; 53(12): 3880–9.

76. Makrygiannakis D, af Klint E, Catrina SB et al. Intraarticular Corticosteroids Decrease Synovial RANKL Expression in Inflammatory Arthritis. Arthritis Rheum 2006; 54(5): 1463–72.

77. Weitoft T1, Uddenfeldt P. Importance of synovial fluid aspiration when injecting intraarticular corticosteroids. Ann Rheum Dis 2000; 59(3): 233–5.

78. Dernis E, Ruyssen–Witrand A, Mouterde G et al. Use of glucocorticoids in rheumatoid arthritis – Practical modalities of glucocorticoid therapy: Recommendations for clinical practice based on data from the literature and expert opinion. Joint Bone Spine 2010; 77: 451–7.

79. Hashkes PJ, Laxer RM. Medical treatment of juvenile idiopathic arthritis. JAMA 2005; 294(13): 1671–84.

80. McAlindon TE, Bannuru RR, Sullivan MC et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartil 2014; 22(3): 363–88.

81. Scherer J, Rainsford KD, Kean CA et al. Pharmacology of intra-articular triamcinolone. Inflammopharmacol 2014; 22: 201–17.

82. Garg N, Perry L, Deodhar A. Intra–articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids. Clin Rheumatol 2014; 33(12): 1695–706.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account