Unusual complications associated with local microcrystalline corticosteroid injections were observed in four patients with diverse rheumatic disorders. Adverse reactions included (1) bilateral digital flexor tendon rupture following carpal tunnel injection for idiopathic median nerve compression syndrome; (2) bowstring deformity of a finger after local corticosteroid treatment of psoriatic digital flexor tendonitis; (3) carpal tunnel infection following dorsal arthrocentesis of a wrist in a patient with rheumatoid arthritis; and (4) pronounced flushing of the face, neck, and chest after intrasynovial corticosteroid injection in a patient with psoriasis and arthritis. This article considers some physiologic actions of corticosteroids possibly responsible for development of these untoward effects.
Postmortem specimens from a patient with rheumatoid arthritis who had received 5 g of aurothioglucose were examined histologically, and their gold content was determined by activation analysis. The highest concentration of gold was found in the lymph nodes followed by the adrenal gland, renal cortex and other organs of the reticuloendothelial system. Comparatively low concentrations were found in tissues comprising the joint structure. Organs in which the greatest quantities of gold were stored include the bone marrow, liver, skin and bone. These findings demonstrate the body's capacity to store relatively large quantities of gold without adverse reaction, support the concept of a systemic rather than local mechanism of action (at the joint level) and demonstrate in vivo gold concentrations in the range expected to produce local cellular biologic effects.The metabolic and excretory pathways of gold compounds have been of interest to investigators since their benefit in the treatment of rheumatoid arthritis was first reported more than 40 years ago (1). Abundant data are available regarding gold concentrations in blood and its components and in the urine and feces of human and experimental animal models (2-6). T' issue distribution of gold, on the other hand, has been adequately studied only in animals (7,8) Submitted for publication Apr 6, 1971; accepted June 21, 1971. tissues has never been systematically measured. There are scanty reports of gold levels in human skin, synovium, synovial fluid, etc, but methods of gold analysis were relatively insensitive and some of the patients studied had received only one injection of a radioactive gold-labeled compound rather than a course of gold therapy (2,3,9,10). No information is available regarding gold concentrations in internal organs or in the musculoskeletal system of a patient with rheumatoid arthritis on longterm chrysotherapy. The sudden death of such a patient afforded us the opportunity to analyze tissues for their gold content.
CASE REPORTMV was a 68-year-old white female with classic rheumatoid arthritis, by the ARA criteria. of 16 years duration who died in November 1969, of an overdose of barbiturate. When first seen in the Arthritis Clinic at Jackson Memorial Hospital in June 1958, she related a 5-year history of progressive polyarthritis with morning stiffness. Physical examination showed active synovitis of metacarpal phalangeal and proximal interphalangeal joints,
16Arthritis and Rheumatism, Vol. 15, No. 1 (Januafy-FebrurIy 1 9 n )
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.