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Glucocorticoid resorption and effects on the hypothalamic-pituitary adrenal axis after intra-articular treatment of the knee in mobile and resting patients
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
In: Ann Rheum DisArticle in journal (Refereed) Submitted
URN: urn:nbn:se:uu:diva-93336OAI: oai:DiVA.org:uu-93336DiVA: diva2:166784
Available from: 2005-09-08 Created: 2005-09-08Bibliographically approved
In thesis
1. Intra-articular Glucocorticoid Treatment: Efficacy and Side Effects
Open this publication in new window or tab >>Intra-articular Glucocorticoid Treatment: Efficacy and Side Effects
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Intra-articular glucocorticoid injection therapy is frequently used to relieve symptoms of arthritis, but there is considerable variation in injection routines among physicians. One issue of debate concerns the importance of synovial fluid aspiration during the injection procedure. In the present randomised controlled study of patients with rheumatoid arthritis (RA), a significantly reduced risk for arthritis relapse was observed when arthrocentesis was included in the intra-articular injection procedure of the knee.

Furthermore, there is no consensus about the post-injection regimes. Previous studies have shown beneficial effects of post-injection rest of the knee, but also injection routines for other joints often include such recommendations. The present randomised controlled trial showed that 48-hour rest in elastic orthosis after intra-articular injection in the wrist did not improve the outcome. Thus, the effect of post-injection rest varies between different joints.

The improved treatment result of post-injection rest of the knee is supposed to be caused by retarded steroid resorption from the joint. In order examine the metabolic effects in cartilage, bone and the hypothalamic-piuitary-adrenal (HPA)-axis, resting and mobile RA patients were studied after intra-articular knee injections. Serum levels of the injected glucocorticoid, triamcinolone hexacetonide (THA), were analysed, as well as cartilage oligomeric matrix protein (COMP) as a marker of cartilage turnover, osteocalcin for bone formation and deoxypyridinoline for bone resorption. The HPA-axis was assessed using serum levels of cortisol and adrenocorticotropine hormone. The result showed a short term and reversible suppression of the HPA-axis and bone formation, whereas bone resorption was unaffected. No differences between mobile and resting patients were observed. In both groups reduction of COMP levels were seen, but these were significantly more pronounced in resting patients, suggesting a cartilage-protective effect. The THA levels increased similarly in both groups, indicating that rest did not affect glucocorticoid resorption.

Consequently, another explanation for the beneficial effects of postinjection rest of knee synovitis should be considered. In the present material the incidence of infectious complications of intra-articular treatment was less than 1/12,000 injections.

The findings in this thesis can be applied in the clinical practice and should be considered when new guidelines for intra-articular glucocorticoid therapy are created.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 49 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 59
Medicine, arthritis, intra-articular glucocorticoid, triamcinolone hexacetonide, arthrocentesis, bone metabolism, cartilage, cortisol, ACTH, joint infection, Medicin
National Category
Dermatology and Venereal Diseases
urn:nbn:se:uu:diva-5897 (URN)91-554-6312-6 (ISBN)
Public defence
2005-09-30, Robergsalen, Akademiska sjukhuset, ing 40, Uppsala, 09:15
Available from: 2005-09-08 Created: 2005-09-08Bibliographically approved

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