Serum methylprednisolone levels following intra-articular injection of methylprednisolone acetate.

Armstrong, Ray; English, J.; Gibson, T.; Chakraborty, J.; Marks, Vincent

doi:10.1136/ard.40.6.571

Cited by 107 publications

(60 citation statements)

References 7 publications

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“…The rate of absorption and duration of action are related to solubility of the compound, and triamcinolone hexacetonide is the most insoluble preparation currently available (16). Depending on the formulation, a steroid can be detected in synovial fluid up to 14 days after injection (29).…”

Section: Discussionmentioning

confidence: 99%

Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

Lambert

Hutchings

Grace

et al. 2007

Arthritis & Rheumatism

134

110

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Objective. To determine the efficacy of fluoroscopically guided corticosteroid injection for hip osteoarthritis (OA) in a randomized, double-blind, placebocontrolled trial.Methods. Fifty-two patients with symptomatic hip OA were randomly allocated to receive placebo (10 mg bipuvicaine, 2 ml saline) (n ‫؍‬ 21) or corticosteroid treatment (10 mg bipuvicaine, 40 mg triamcinolone hexacetonide) (n ‫؍‬ 31). Patients were followed up for 1, 2, 3, and 6 months. The primary outcome measure was the pain improvement response, defined as a 20% decrease in the Western Ontario and McMaster Universities OA Index (WOMAC) pain score (on 5 100-mm visual analog scales [VAS]) (WOMAC20) from baseline to 2 months postinjection. Secondary outcomes were a 50% decrease in the WOMAC pain score (WOMAC50), changes in other WOMAC subscale scores, patient's global assessment of health (on a 100-mm VAS), and Short Form 36 (SF-36) quality of life indices. Analyses were based on the intent-to-treat principle.Results. The mean WOMAC pain score fell 49.2% (decreasing from 310.1 mm to 157.4 mm) at 2 months postinjection in patients receiving corticosteroid, compared with a decrease of 2.5% (from 314.3 mm to 306.5 mm) in the placebo group (P < 0.0001). The proportion of WOMAC20 responders at 2 months' followup was significantly higher in the corticosteroid group (67.7%) compared with the placebo group (23.8%) (P ‫؍‬ 0.004); similar proportions of WOMAC50 responders were observed between groups (61.3% in the corticosteroid group versus 14.3% in the placebo group; P ‫؍‬ 0.001). Response differences were maintained at 3 months' followup (58.1% responders in the corticosteroid group versus 9.5% responders in the placebo group; P ‫؍‬ 0.004). Significant differences in the WOMAC stiffness and physical function scores (P < 0.0001), patient's global health scores (P ‫؍‬ 0.005), and SF-36 physical component scores (P ‫؍‬ 0.04) were observed, with patients in the corticosteroid group showing greater improvements. There were no differences in the frequency of adverse events between groups.Conclusion. This placebo-controlled trial confirms that corticosteroid injection can be an effective treatment of pain in hip OA, with benefits lasting up to 3 months in many cases. Future studies should address questions related to the benefits of repeated steroid injection and the effects of this treatment on disease modification.Osteoarthritis (OA) affects all vertebrates, and the prevalence of the disease increases exponentially with age. Estimates of the prevalence of hip OA in humans range from 2% at age 35 years to 35% at age 85 years or older (1), and autopsies have shown that cartilage degeneration can be detected in patients as early as the second decade of life (2). A disease prevalence estimate of 3% among North Americans older than age 55 years has been commonly quoted, but this may well be an underestimate of the true burden of hip OA in the general population (3,4). The prevalence of the disease has significant fiscal implications, since it has

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Section: Discussionmentioning

confidence: 99%

Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

Lambert

Hutchings

Grace

et al. 2007

Arthritis & Rheumatism

134

110

View full text Add to dashboard Cite

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“…Enfin, il existe un effet anti-inflammatoire systémique des infiltrations secondaire au passage systémique du produit corticoïde [30], expliquant que l'effet thérapeutique ne se limite pas au site d'injection, l'état des articulations inflammées s'améliorant parallèlement à celle infiltrée.…”

Section: Tableau 3 Modifications Observées Après Trois Infiltrations unclassified

Effets systémiques des infiltrations de glucocorticoïdes épidurales et intra-articulaires chez les patients diabétiques et non diabétiques

Younès

Neffati

Touzi

et al. 2007

Revue du Rhumatisme

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“…However, plasma cortisol concentrations remain suppressed for up to a week following intra-articular steroid (Armstrong et al, 1981), and if the mechanism involved enzyme induction, for instance, duration will be dependent upon the half-life of the protein or proteins involved.…”

Section: Patientmentioning

confidence: 99%

The effect of intra‐articular steroids on plasma salicylate concentrations.

Edelman¹,

Jm²,

Hackett³

1986

Brit J Clinical Pharma

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1 Plasma salicylate concentrations and salicylate clearances were evaluated in 10 patients before and then 3 days after the intra-articular administration of glucocorticoid steroids.All patients were on chronic salicylate treatment, the dosage varying from 1.3-4.6 g day-1 of enteric-coated aspirin. 2 The mean steady state plasma concentration (+ s.e. mean) of salicylate decreased significantly after intra-articular steroid (90.9 + 14.8 mg 1-1 -64.7 + 8.9, P < 0.05), whilst the mean clearance increased significantly (87.3 + 20.6 ml min-1-120.6 + 28.3, P < 0.05). 3 In these paired studies, the intra-articular administration of steroids lead to a significant decrease in plasma salicylate levels in patients taking enteric-coated aspirin.

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Serum methylprednisolone levels following intra-articular injection of methylprednisolone acetate.

Cited by 107 publications

References 7 publications

Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

Effets systémiques des infiltrations de glucocorticoïdes épidurales et intra-articulaires chez les patients diabétiques et non diabétiques

The effect of intra‐articular steroids on plasma salicylate concentrations.

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