Effect of intra-articular corticosteroid injections on primate cartilage.

Gibson, T.; Burry, H. C.; Poswillo, David; Glass, Jon R

doi:10.1136/ard.36.1.74

Cited by 70 publications

(27 citation statements)

References 26 publications

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“…The differences in our observations compared with those of the others may be multifactorial. Generalization regarding nonprimate cartilage used in the above studies of human cartilage may not be possible [20]. The cytoarchitecture of cartilage in rabbit medial femoral condyles, for example, has a much higher density of chondrocytes when compared with human cartilage [17].…”

Section: Discussionmentioning

confidence: 99%

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Syed¹,

Green²,

Bianski³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Intraarticular injections of corticosteroids combined with local anesthetics are commonly used for management of chronic pain symptoms associated with degenerative joint diseases and after arthroscopic procedures. Several studies suggest chondrotoxicity of local anesthetics whereas others report chondroprotective and cytotoxic effects of corticosteroids on cartilage. Given the frequency of use of these agents, it is important to know whether they are in fact toxic. Questions/purposes We asked whether (1) bupivacaine and triamcinolone acetonide, alone and combined, were chondrotoxic to chondrocytes in culture; (2) buffering of the reagents diminished toxicity of the bupivacaine and triamcinolone; and (3) the presence of the superficial layer of articular cartilage protects against toxicity. Materials and Methods We obtained cartilage from three patients undergoing arthroplasty. To address triamcinolone acetonide, bupivacaine, and combinatorial toxicity to human chondrocytes, we set up monolayer chondrocyte cultures (n = 8 wells per condition). The question of buffering was addressed by performing the same assays as above, but the reagents were buffered. An MTT assay was used to assess chondrocyte survival in the monolayer. We harvested 21 articular plugs from each of three patients (total 63 plugs) and exposed them to the same reagents as above, including the buffered reagents. A Live/Dead assay was used to determine chondrocyte survival. Results Triamcinolone acetonide, bupivacaine, and their combination were toxic to human chondrocytes in the monolayer comparisons. The addition of buffering did not mitigate chondrocyte death. With the intact superficial layer in the plug group, bupivacaine was not toxic as compared with for the control group; all the other reagents (triamcinolone, combination bupivacaine/triamcinolone, buffered bupivacaine, buffered triamcinolone, and buffered combination) produced chondrotoxicity. Conclusions Triamcinolone induced chondrotoxicity in the articular plug and monolayer culture, whereas bupivacaine induced chondrotoxicity only in monolayer culture. The combined used of triamcinolone and bupivacaine did not show additive chondrocyte death in any arm. Buffering of bupivacaine increased its chondrotoxicity. Clinical Relevance Although not necessarily reflecting in vivo conditions, our data suggest physicians should be cognizant of the potential in vitro chondrotoxicity of bupivacaine and triamcinolone when contemplating intraarticular administration.

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Section: Discussionmentioning

confidence: 99%

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Syed¹,

Green²,

Bianski³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…However, the repeated use of IA corticosteroid in nonprimates has been associated with limited cartilage damage (37,38). Studies using both in vitro human cartilage explants and primate models have not demonstrated long-term adverse effects on cartilage (39,40). Despite large numbers of intrasynovial injections over the years, there are relatively few anecdotal reports of glucocorticoid arthropathy in humans (41).…”

mentioning

confidence: 99%

The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis

Emkey

Lindsay

Lyssy

et al. 1996

Arthritis & Rheumatism

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Objective. To assess the effects of intraarticular (IA) corticosteroid use on bone metabolism in patients with rheumatoid arthritis (RA).Methods. Levels of the bone turnover markers, serum osteocalcin (BGP) and urinary pyridinoline (PYD), were monitored in RA patients for 4 weeks following a single IA administration of xylocaine alone or in combination with triamcinolone acetonide.Results. Levels of the bone resorption marker, PYD, did not show any significant change, whereas BGP levels were drastically decreased 1 day after IA administration of corticosteroid, and then returned to pretreatment levels by day 14. The efficacy of IA corticosteroid treatment lasted for 4 weeks.Conclusion. Our results suggest that IA administration of corticosteroid has no net effects on bone resorption and only a transient systemic effect on bone formation. IA corticosteroid administration may be better for bone metabolism than continuous use of orally administered corticosteroid.

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“…Mankin et a1 (24) showed that IA steroids administered to rabbits, impaired cartilage synthesis and accelerated cartilage fissuring. In contrast, repeated IA steroid injections appeared to have no detrimental effect in monkeys (25). Moreover, the effects of IA steroids on synovium, which is considered the major tissue responsible for the synthesis of SF HA and which may control the rate of clearance of HA from the joint, are not well documented.…”

mentioning

confidence: 92%

Circulating and synovial fluid hyaluronan levels

Pitsillides

Will

Bayliss³

et al. 1994

Arthritis & Rheumatism

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Objective. To assess the effect of intraarticular (IA) corticosteroid on hyaluronan (HA) concentrations in synovial fluid (SF) and serum and the clearance of '311-labeled albumin from the joints of patients with rheumatoid arthritis (RA), osteoarthritis (OA), and ankylosing spondylitis (AS).Methods. SF and serum were collected before and 2 weeks and 2 months after IA steroid injection. The HA concentration was assessed using an enzyme-linked immunosorbent assay and '3'I-albumin clearance from joints was assessed using an external gamma counter.Results. In RA patients, HA concentrations in the SF were increased following IA steroids, while the serum concentrations were decreased. In OA patients, HA concentrations in SF tended to increase initially (decreasing thereafter), and were associated with increased HA concentrations in serum. There were less marked alterations in the AS patients. Albumin clearance rates were decreased significantly (2 weeks postinjection) only in the RA patients. Estimated HA flux revealed discrepancies between the HA concentration and the rate of flux in RA and AS patients. Conclusions. These findings suggest that IA steroid injection is associated with a restoration in the Supported by the Arthritis and Rheumatism Council of Great Britain.

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Effect of intra-articular corticosteroid injections on primate cartilage.

Cited by 70 publications

References 26 publications

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis

Circulating and synovial fluid hyaluronan levels

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