INTRAARTICULAR CORTICOSTEROIDS IN ARTHRITIC DISEASE - A GUIDE TO TREATMENT

Intra-articular corticosteroid injections are widely used in aseptic a rthritis, most often as a supplement to systemic anti-inflammatory the rapy. Suppression of local joint inflammation by corticosteroids is ra pid and pronounced, and may be achieved with only minor systemic effec ts; however, this suppression is usually only temporary. The original compound hydrocortisone acetate has been replaced by longer-acting pre parations such as methylprednisolone acetate, triamcinolone acetonide and triamcinolone hexacetonide. In controlled studies, triamcinolone h exacetonide has proved most effective, providing clinical effect for a mean period up to several months. However, this compound frequently c auses local tissue necrosis when injected outside a synovial cavity, a nd it should be used only by experienced clinicians. Indications for i ntra-articular corticosteroids include mono-or oligoarthritis in rheum atoid arthritis and other aseptic inflammatory joint diseases. Intra-a rticular corticosteroids are also used in osteoarthritis, but in contr olled studies the effect is brief and transient. A number of potential adverse effects of intra-articular corticosteroids stress the importa nce of their judicious use. The risk of cartilage damage and progressi ve joint destruction is a controversial issue. The results of animal s tudies are ambiguous. Despite case reports of severe arthropathy, most studies on humans suggest that, when used appropriately, the benefici al effects of infra-articular corticosteroids exceed the harmful effec ts. Nevertheless, it is recommended that corticosteroid injections int o the same joint should be limited, for instance to 1 injection every 6 weeks and no more than 3 to 4 in 1 year. Prior to intra-articular co rticosteroid injections the indications and contraindications should a lways be considered. In particular, infection should be ruled out. Str ict aseptic technique is essential to avoid iatrogenic septic arthriti s. Correct intra-articular corticosteroid therapy is of great clinical value in the management of aseptic arthritic disease.