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
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.
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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