Intra-articular Steroids - Lucy Dennell 10/01/2004

First used by Thorn in 1950in RA knee

Attempt to decrease solubility by adding a methyl group to prednisolone
Fluoride to cortisol as anacetonide salt = triamcinolone acetate considerably less soluble and more potent

How long do they stay in the joint? Prednisolone T 1/2 2 hours/ Triamcinolone mean T 1/2 4.6days (Derendorf)

Efficacy

Systematic review of RCTs showed a +ve effect but short lived balanced by a powerful placebo effect. The best of these RCTS and most often quoted is that by Dieppeet al which found a +ve effect of Triamcinolone hexacetonide compared to placebo at 6/52, parallel/crossover single blind study

Also aspirating the joint if an effusion and restare thought to enhance the effect.

Author

Wang, Jhi-Joung et al Taipei , Taiwan

Title

Intrarticular triamcinolone acetonide for pain control after arthroscopic knee surgery

Reference

Anesthesia + Analgesia vol 87(5), Nov 1998, 1113-6

Summary

Prospective , randomised , double blind study. 60 patients. Group 1 had 10 mg Triamcinolone Gp 2 had saline. Outcomes were VAS and time to first dose of rescue analgesia in the 24 post op. None in group 1 reqd rescue analgesia in the period 6-24 hrs post op, but 53% in Gp2. VAS signif lower in Gp16-24 hr.

Critique

A well designed study with enough subjects to allow for statistical power to be adequate despite loss of 3 pts

Adverse effects

Effects on cartilage

Concernabout effects on cartilage mainly derived from animal studies esp in rabbitsMankin JBJS 1966, Salter JBJS1969 and Behrens JBJS 1975

These concerns not borne out in in vitro studies on human tissue. Not many long term follow up studies in humans;




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