INTRAARTICULAR CORTICOSTEROIDS - GUIDE TO SELECTION AND INDICATIONS FOR USE

Physicians have used intra- and periarticular corticosteroids for trea ting a variety of rheumatic diseases for nearly 50 years. Yet publicat ions that have carefully examined the mechanisms of action, the pharma cokinetics and the comparative safety and efficacy of the available ag ents are sparse. This limits our ability to choose a drug scientifical ly. Similarly, we know little about the long term outcomes of joints i njected with corticosteroids versus those not injected. Highly branche d esters of methylprednisolone or triamcinolone are the preferred agen ts used by American rheumatologists. Pharmacokinetic studies reveal th at triamcinolone hexacetonide, the least soluble of all the corticoste roid esters, is retained in the joint for 2 to 3 weeks. Intra-articula r corticosteroids may implement their anti-inflammatory effect by down -regulating genetic expression of several pro-inflammatory proteins. A literature review suggests that judicious use of intra- and periartic ular corticosteroids is very helpful in temporarily reducing pain and inflammation in musculoskeletal structures and may facilitate increase d motion and function in selected cases. Their use in juvenile arthrit is also appears to be safe and beneficial. Infection in or about the j oint is the chief contraindication to use. Adverse effects are very fe w but the number of injections per joint should probably be limited to 4 or less per year.