Glucocorticoid resorption and influence on the hypothalamic-pituitary-adrenal axis after intra-articular treatment of the knee in resting and mobile patients.
2006 (English)In: Ann Rheum Dis, ISSN 0003-4967, Vol. 65, no 7, 955-7 p.Article in journal (Refereed) Published
BACKGROUND: Studies have shown that intra-articular glucocorticoid injection treatment for knee synovitis has a better outcome in resting patients than in mobile patients. One reason for this observation might be that rest retards steroid resorption, causing an enhanced local treatment effect. OBJECTIVES: To study drug resorption and the impact on hormone production in the hypothalamic-pituitary-adrenal axis after intra-articular glucocorticoid administration, with and without postinjection rest. METHODS: Twenty patients with rheumatoid arthritis and knee synovitis were randomised to either 24 hour bed rest or normal activity after intra-articular glucocorticoid treatment with 20 mg triamcinolone hexacetonide (THA). Serum levels of THA, cortisol, and adrenocorticotropic hormone (ACTH) were followed during 2 weeks. RESULTS: Short term and reversible decreases in serum cortisol and ACTH levels (p<0.001) were seen, without any significant differences between resting and mobile patients. The THA levels increased similarly in both groups, with the median serum peak seen after 8 hours. CONCLUSION: Immobilisation does not appear to retard glucocorticoid resorption after intra-articular administration. Further studies are therefore needed to clarify the mechanism behind the beneficial effects of rest after intra-articular glucocorticoid treatment for knee synovitis.
Place, publisher, year, edition, pages
2006. Vol. 65, no 7, 955-7 p.
Absorption, Adrenocorticotropic Hormone/blood, Adult, Aged, Arthritis; Rheumatoid/drug therapy/metabolism, Bed Rest, Female, Glucocorticoids/blood/*metabolism/therapeutic use, Humans, Hydrocortisone/blood, Hypothalamo-Hypophyseal System/*drug effects, Injections; Intra-Articular, Knee Joint, Male, Middle Aged, Pituitary-Adrenal System/*drug effects, Statistics; Nonparametric, Synovial Membrane/metabolism, Synovitis/*drug therapy/metabolism, Triamcinolone Acetonide/*analogs & derivatives/blood/therapeutic use
IdentifiersURN: urn:nbn:se:uu:diva-25112PubMedID: 16769782OAI: oai:DiVA.org:uu-25112DiVA: diva2:52886