Plasmakonzentration und systemische Wirkung von Betamethason nach intraartikulärer Injektion

Abstract

Plasma concentrations of betamethasone, cortisol and corticosterone were measured before and after intraarticular injection of a betamethasone-depot preparation (Celestan-Depot) by radioimmuno-assay in 31 patients. Plasma concentration of betamethasone reached its maximum of between of 10 and 17 microgram/dl 30 min after injection. It had fallen to half after 2 hours, and practically to nil from the eighth day onwards. Lowest plasma levels of cortisol and corticosterone occurred after 6--24 hours, returning to the normal range after four days. In nine patients with knee-joint effusion and synovitis the plasma concentration of betamethasone was significantly higher after 24 hours, and cortisol and corticosterone values after 48 hours significantly more suppressed, than in patients without joint effusions and signs of inflammation. The results indicate that plasma concentration of betamethasone and the suppressant effect on the adrenal cortex after intra-articular injection is similar to that after intramuscular applications. Correspondingly, systemic application of the cortisol derivatives can cause significant side effects and be contra-indicated also after intra-articular injection.

Simultaneous Bilateral Knee Injection of Methylprednisolone Acetate and the Hypothalamic-Pituitary Adrenal Axis: A Single-Blind Case-Control Study

“…There are pros and cons for simultaneous IAIs; the pros include ( a ) saving money and time; ( b ) continuous knee pain at 1 side may overshadow the improvement in the other side; ( c ) bilateral improvement may have remarkable impact on patient mobility, stability, and function; ( d ) the SAI was subclinical and transient; ( e ) a second IAI performed later may even cause a prolonged SAI. 18 …”

Elimination profile of triamcinolone hexacetonide and its metabolites in human urine and plasma after a single intra‐articular administration

“…On the other hand, some studies have shown a decrease in plasma concentrations of cortisol (CORT) after IA administration of some GCs, which indicates inhibition of the HPA axis, and therefore, a systemic effect . Apart from CORT plasma concentrations, some of the side effects observed after IA administration of GCs also suggest systemic effect .…”

“…On the other hand, some studies have shown a decrease in plasma concentrations of cortisol (CORT) after IA administration of some GCs, which indicates inhibition of the HPA axis, and therefore, a systemic effect. [28][29][30] Apart from CORT plasma concentrations, some of the side effects observed after IA administration of GCs also suggest systemic effect. 31,32 However, some authors claim that these systemic effects are due to a wrong IA administration because of the difficulties to administer the GC inside the joint.…”

Effect of corticosteroids on articular cartilage: have animal studies said everything?

“…After intra‐articular administration of a suspension, the concentration of CS in the synovial fluid peaks rapidly and reaches a level depending on the process of release of the drug from the pharmaceutical formulation, rate of bioactivation of the prodrug, and absorption from joint to blood. For example, TH suspension releases the steroid slower than TA due to its lower solubility, while TA and TH are less soluble than BP .…”