Use
Intra-articular injection of corticosteroids can be useful in patients who have failed treatment with NSAIDs. They have minimal risk of systemic side effects. Suppression of hypothalamic-pituitary-adrenal axis hasn’t been reported with intra-articular injections.
Aspiration is not performed unless there is tense effusion.
Weight bearing joints should be rested for 24 hours after injection.
Relief will typically last from 0-6 months. injections should not be repeated more than 3-4 times year. relief tends to last longer in smaller (non-weight bearing) joints.
Used within 8 hours of SCI.
Actions
Cross cell membrane to interact with cell DNA & RNA.
Inhibit production of phospholipase A2.
Pharmacokinetics
Crystalline preparations (eg triamcinolone hexacetonide) offer slower absorption & prolonged effects compared with more soluble versions but at risk of corticosteroid-crystal induced inflammation.
Side effects
Subcutaneous fat atrophy
Skin pigmentation
Inflammatory flare from crystal induced inflammation.
Systemic side effects
Decrease calcium absorption, osteoporosis.
Decrease collagen formation & ↓ tensile strength of scars.
AVN
Calcitriol (1,25-dihydroxyvitaminD) decreases rate of osteoporosis.