Intra-articular Injection Of Triamcinolone Acetonide Research Articles

Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation.

Corticosteroids are a commonly used, inexpensive intra-articular treatment for osteoarthritis which may increase the risk for laminitis in horses due, in part, to hyperinsulinaemia. Humans with metabolic syndrome experience increases in insulin and glucose concentrations post-injection, but responses in horses are unknown. To determine the effect of a single intra-articular (IA) dose of triamcinolone acetate (TA) on blood insulin and glucose concentrations. Before-after study. Ten horses with normal insulin regulation as assessed by an oral sugar test received 18 mg of TA into one middle carpal joint. Insulin and glucose concentrations were evaluated at baseline and 4, 6, 8, 24, 48, and 72 h following IA corticosteroid injection. Differences from baseline were evaluated using a repeated measures ANOVA with Dunnett's multiple comparison testing or a Friedman test with Dunn's correction (significant at p < 0.05). Mean ± SD blood insulin concentration post IA TA injection was increased at 6 h (15.8 ± 3.1 μIU/mL, p = 0.01), 24 h (23 ± 5.8 μIU/mL, p ≤ 0.001), and 48 h (29 ± 13 μIU/mL, p ≤ 0.01) compared to baseline (10 ± 12.3 μIU/mL), with the peak at 48 h. Median ± 95% CI blood glucose concentration post IA TA injection was increased at 6 h (112.7 ± 20.3 mg/dL, p = 0.006), 8 h (112.9 ± 21.4 mg/dL, p = 0.004), 24 h (122.6 ± 14.6, p ≤ 0.0001), and 48 h (123.5 ± 15.4 mg/dL, p ≤ 0.0001) compared to baseline (89.2 ± 6.6 mg/dL), with the peak at 48 h. Only horses with normal insulin regulation were evaluated. Blood insulin and glucose concentrations modestly increased for 48 h following IA TA.

Short term effects of intraarticular triamcinolone acetonide injection on serum testosterone, luteinizing hormone, and follicle stimulating hormone levels in male veterans: A prospective pilot study.

Despite the common practice of intraarticular corticosteroid injections (ICSIs) for peripheral joint disease, little is known about their systemic effects on the hypothalamic-pituitary-gonadal axis. To assess the short-term effects of ICSIs on serum testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels together with changes in Shoulder Pain and Disability Index (SPADI) scores in a veteran population. Prospective pilot study. Outpatient musculoskeletal clinic. Thirty male veterans, median age 50 (range 30-69) years. Ultrasound-guided glenohumeral joint injection using 3 mL of 1% lidocaine HCl and 1 mL of 40 mg triamcinolone acetonide (Kenalog). Serum T, FSH, and LH levels, Quantitative Androgen Deficiency in the Aging Male (qADAM), and SPADI questionnaires at baseline, 1, and 4 week(s) post procedure. At 1 week post injection, serum T levels decreased by 56.8 ng/dL (95% confidence interval (CI): 91.8, 21.7, p = .002) compared with baseline. Between 1 and 4 weeks post injection, serum T levels increased by 63.9 ng/dL (95% CI: 26.5, 101.2, p = .001), recovering to near baseline levels. SPADI scores were reduced at 1 week (-18.3, 95% CI: -24.4, -12.1, p < .001) and 4 weeks (-14.5, 95% CI -21.1, -7.9, p < .001). A single ICSI can temporarily suppress the male gonadal axis. Future studies are needed to evaluate for long-term effects of multiple injections at a single setting and/or higher corticosteroid doses on male reproductive axis function.

Outcomes of intraarticular triamcinolone acetonide injection in children with non-systemic juvenile idiopathic arthritis.

The objectives were to explore the response to intraarticular triamcinolone acetonide (TA) injection in children with non-systemic juvenile idiopathic arthritis (JIA) and factors associated with time to arthritis flare. This was a retrospective cohort study of children with non-systemic JIA who received intraarticular TA injections at a tertiary care hospital in Bangkok, Thailand. Response to intraarticular TA injection was defined as absence of arthritis at 6months after procedure. Time from joint injection to arthritis flare was recorded. Kaplan-Meier survival analysis with logarithmic rank test and multivariable Cox proportional hazards regression analysis were used for outcome analyses. Intraarticular TA injection was performed in 177 joints among 45 children with non-systemic JIA, most common in the knees (57 joints, 32.2%). Response to intraarticular TA injection at 6months was observed in 118 joints (66.7%). Ninety-seven joints (54.8%) had arthritis flare following injection. The median time to arthritis flare was 12.65months (95%CI 8.20-17.10months). The significant risk factor associated with arthritis flare was the JIA subtypes other than persistent oligoarthritis (HR 2.62, 95%CI 1.085-6.325, p = 0.032); the significant protective factor was concomitant sulfasalazine use (HR 0.326, 95%CI 0.109-0.971, p = 0.044). Adverse effects included pigmentary changes (3, 1.7%) and skin atrophy (2, 1.1%). Intraarticular TA injection in children with non-systemic JIA had favorable response in two thirds of injected joints at 6months. The JIA subtypes other than persistent oligoarthritis was a predictor of arthritis flare following intraarticular TA injection. Key Points • Intraarticular TA injection in children with non-systemic JIA had a favorable response in two-thirds of injected joints at 6 months. • The median time from intraarticular TA injection to arthritis flare was 12.65 months. • The risk factor predicting arthritis flare was the JIA subtypes other than persistent oligoarthritis (extended oligoarthritis, polyarthritis, ERA, and undifferentiated JIA), while the concomitant use of sulfasalazine was a protective factor. • Local adverse reactions from intraarticular TA injection were less than 2% of injected joints.

Efficacy of tumor necrosis factor inhibitor combined with intra-articular injection of triamcinolone acetonide in the treatment of refractory rheumatoid arthritis synovitis: a retrospective study.

To investigate whether there is a difference in the efficacy of intra-articular injection of tumor necrosis factor (TNF) inhibitor and triamcinolone acetonide (HA) in rheumatoid arthritis (RA) patients with recurrent synovitis after the first intra-articular injection of HA. RA patients who relapsed 12weeks after the first HA treatment were enrolled in this study. After joint cavity extraction, recombinant human TNF receptor-antibody fusion protein (TNFR:FC) (25mg or 12.5mg) or HA (1ml or 0.5ml) was injected then. The changes in the visual analog scale (VAS), joint swelling index, and joint tenderness index before and 12weeks after reinjection were compared and analyzed. The changes in synovial thickness, synovial blood flow, and fluid dark zone depth before and after reinjection were observed by ultrasound. Forty-two RA patients were enrolled, including 11 males and 31 females, with an average age of 46.79 ± 12.61years and an average disease duration of 7.76 ± 5.44years. After 12weeks of intra-articular injection of HA or TNFR:FC, the VAS scores were significantly lower than those before treatment (P < 0.01). After 12weeks of injection, the scores of the joint swelling index and tenderness index in both groups were significantly decreased compared with those before treatment. There was no significant difference in synovial thickness under ultrasound in the HA group before and after injection, while the synovial thickness in the TNFR:FC group was significantly improved after 12weeks (P < 0.01). After 12weeks of injection, the grade of synovial blood flow signal in both groups decreased significantly compared with that before treatment, especially in the TNFR:FC group. After 12weeks of injection, the depth of the liquid dark area under ultrasound decreased significantly in the HA group and TNFR:FC group compared with that before treatment (P < 0.01). Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. Compared with HA treatment, it can reduce synovial thickness. Key Points • Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids can not only relieve joint pain but also significantly inhibit joint swelling. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids cannot only improve synovial inflammation but also inhibit synovial proliferation. • For the treatment of refractory RA synovitis, biological agents combined with glucocorticoid injection are an effective and safe option.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment

Increase in range of motion after intra-articular injection of triamcinolone acetonide for the treatment of frozen shoulder is related to body mass index.

The aim of this study was to evaluate the clinical effect of glenohumeral injection with triamcinolone acetonide for frozen shoulder and to identify the factors related to extent of range of motion (ROM) recovery. Between July 2015 and May 2020, a total of 305 patients with primary frozen shoulder (147 males, 158 females; mean age: 55.8±4.3 years; range, 52 to 73 years) who underwent intra-articular glenohumeral injection of triamcinolone acetonide were retrospectively analyzed. The primary outcome measure was the range of changes in each aspect of ROM at six weeks after injection. The relationship between improvement and unresponsiveness to intra-articular injection for the treatment of frozen shoulder with various factors were evaluated. The analyzed factors were as follows: age, sex, body mass index (BMI), initial ROM before injection, symptom duration, hand dominance, smoking history, and the existence of underlying disease including diabetes mellitus, hypertension, coronary disease, thyroid disease, and hypercholesterolemia. There were significant improvements in all aspects of ROM at six weeks after injection. The forward flexion (r=-0.346, p<0.001) and external rotation (r=-0.204, p=0.040) showed a negative correlation with BMI. Multivariate analysis revealed that BMI was the sole factor related to recovery of forward flexion (p=0.032) and external rotation (p=0.007) at six weeks post-injection. Intra-articular injection of triamcinolone acetonide is an effective method for improving ROM in patients with frozen shoulder. Increased BMI showed adverse effects on ROM recovery.

The efficacy and safety of intra-articular injection of triamcinolone acetonide versus triamcinolone hexacetonide for treatment of juvenile idiopathic arthritis

ObjectivesJuvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. Intra-articular corticosteroids joint injection (IAJI), with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA), is an effective additional treatment for oligo and polyarticular JIA. Previous studies have shown the benefits of TH over TA; however, TA is still used in many pediatric rheumatology centers. Our unit has experience with both regimens, and therefore we aimed to compare the efficacy and safety of TA versus TH for JIA patients.MethodsChart review of JIA patients who were randomly (based on drug availability) treated with TA or TH IAJI during 2010–2019. Primary outcomes for efficacy were defined as full recovery from arthritis one month after IAJI and a relapse rate of arthritis 3 months after IAJI. Primary outcome for safety was defined as the occurrence of adverse events (AEs) during the follow up period after IAJI.ResultsOverall, 292 joints of 102 JIA patients were treated (138 TA/154 TH joints). Complete recovery after one month was documented in 107 (69.6%) of TA treated joints and 96 (69.5%) of TH treated joints (P = 0.232). However, rate of relapse after 3 months was significantly higher for TA treated joints (27 (20.1%) vs. 13 (8.8%), respectively, P < 0.01). No AEs were documented except minor scars at four joint injection sites.ConclusionThe recovery from arthritis was similar (~ 70%) with both regimens, however relapse rate was more than double in TA as compared to TH injected joints. These findings are important due to a contemporary shortage of TH in the US market.

Intra-articular injection of triamcinolone acetonide sustains macrophage levels and aggravates osteophytosis during degenerative joint disease in mice.

Background and purposeCorticosteroids such as triamcinolone acetonide (TAA) are potent drugs administered intra‐articularly as an anti‐inflammatory therapy to relieve pain associated with osteoarthritis (OA). However, the ability of early TAA intervention to mitigate OA progression and modulate immune cell subsets remains unclear. Here, we sought to understand the effect of early intra‐articular injection of TAA on OA progression, local macrophages, and peripheral blood monocytes.Experimental approachDegenerative joint disease was induced by intra‐articular injection of collagenase into the knee joint of male C57BL/6 mice. After 1 week, TAA or saline was injected intra‐articularly. Blood was taken throughout the study to analyse monocyte subsets. Mice were killed at days 14 and 56 post‐induction of collagenase‐induced OA (CiOA) to examine synovial macrophages and structural OA features.Key resultsThe percentage of macrophages relative to total live cells present within knee joints was increased in collagenase‐ compared with saline‐injected knees at day 14 and was not altered by TAA treatment. However, at day 56, post‐induction of CiOA, TAA‐treated knees had increased levels of macrophages compared with the knees of untreated CiOA‐mice. The distribution of monocyte subsets present in peripheral blood was not altered by TAA treatment during the development of CiOA. Osteophyte maturation was increased in TAA‐injected knees at day 56.Conclusion and implicationsIntra‐articular injection of TAA increases long‐term synovial macrophage numbers and osteophytosis. Our findings suggest that TAA accentuates the progression of osteoarthritis‐associated features when applied to an acutely inflamed knee.

Retrospective analysis of the effectiveness of local corticosteroid therapy in children with oligoarticular juvenile idiopathic arthritis

Background . Despite the progress in diagnosis and treatment of chronic rheumatic diseases in children, the choice of anti-inflammatory drugs in case of the onset of oligoarticular juvenile idiopathic arthritis (JIA) still remains relevant. Till present, pediatric rheumatologists have not reached a consensus on this issue yet. The aim of this study was to search for predictors of early failure of local steroid therapy and assessment of its feasibility in patients with oligoarticular JIA. Materials and methods. In a retrospective study, 92 children aged 11 months – 9 years with chronic oligoarticular JIA without extra-articular manifestations were monitored. The features of the clinical, instrumental and laboratory diagnosis during the disease onset were studied, along with the dynamics of the articular syndrome and the effectiveness of intra-articular administration of corticosteroid drugs. Results and discussion. The data on 92 children with 164 active joints who received 218 local intra-articular injections of triamcinolone acetonide at the onset of the disease were analyzed. Intra-articular injections of triamcinolone acetonide at a dose of 20–40 mg were performed with an interval of 3, 6, and 12 months, depending on the intensity of the disease. In about one third of children with oligoarticular JIA, arthritis became inactive on average after two intra-articular injections of triamcinolone acetonide. The study did not reveal the predictors of early ineffective topical corticosteroid monotherapy in children. No clinical, instrumental, and laboratory signs were identified that would directly indicate the need for early therapy with methotrexate. Conclusion . Triamcinolone acetonide is an effective and safe drug for children with oligoarticular JIA. Despite the widespread use of biological, gene, and other innovative therapies, application of local corticosteroids as the firstline therapy in children with oligoarticular JIA should not be neglected.

Randomized controlled trial of functional outcome of periarthritis of shoulder (Adhesive Capsulitis) in a group of 60 patients using intraarticular triamcinolone vs. intraarticular platelet rich plasma

Background: Periarthritis shoulder is the most common cause of shoulder pain and stiffness encountered in day to day practice. Though the condition is self-limiting it may not be practical to wait for spontaneous resolution as it is associated with significant morbidity hampering routine activities. The various treatment options available include simple physiotherapy, intra articular injections, manipulation under general anaesthesia and surgical intervention. This study was undertaken to compare the efficacy and safety of two intraarticular injections that is triamcinolone acetonide and platelet rich plasma (PRP). Materials and Methods: Patients with periarthritis shoulder were randomly allocated into two groups. Group A receiving intraarticular triamcinolone acetonide injection and Group B receiving intra articular platelet rich plasma. Patients were followed up every four weeks for 24 weeks. And outcome was assessed using SPADI score before treatment and at every visit. Results were assessed using Epi Data version 2.2.2.186. Results: PRP treatment resulted in statistically significant improvement over triamcinolone acetate therapy in both SPADI and VAS scale. Conclusion: Intraarticular PRP is more effective and safe in treatment of periarthritis shoulder. Keywords: Periarthritis shoulder, Triamcinolone acetonide, Platelet rich plasma.

Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up

BackgroundOsteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Pharmacological treatments for osteoarthritis, such as corticosteroids, produce an immediate reduction of the patient’s pain as well as an improvement in the patient’s mobility and quality of life, but with a limited long-term efficacy. In this context, platelet-rich plasma (PRP) infiltrations represent a therapeutic tool due to its trophic properties and its ability to control inflammatory processes, especially in musculoskeletal applications. The aim of this study is to evaluate and compare the clinical benefits of PRP when injected intra-articularly vs a commonly used corticosteroid (CS, triamcinolone acetonide, Kenalog®) in patients affected by mild to moderate symptomatic knee osteoarthritis.MethodsForty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren-Lawrence grades II–III) were enrolled in this randomized study. Patients randomized in the PRP group (n = 20) received an intra-articular injection of PRP (8 mL) while patients randomized in the CS group (n = 20) received an intra-articular injection of triamcinolone acetonide (1 mL of 40 mg/mL) plus lidocaine (5 mL of 2%). The pain and function of the target knee were evaluated by the VAS, IKDC, and KSS scales at the baseline (V1), 1 week (V2), 5 weeks (V3), 15 weeks (V4), 30 weeks (V5), and 1 year (V6) after treatment.ResultsNo serious adverse effects were observed during the follow-up period. A mild synovitis was registered in 15 patients (75%) in the PRP group within the first week after treatment which resolved spontaneously. Both treatments were effective in relieving pain and improving the knee function in the very short-term follow-up visit (1 week). A high improvement of the subjective scores was observed for both groups up to 5 weeks, with no significative differences between the groups for the VAS, IKDC, or KSS. After 15 weeks of follow-up, the PRP group showed significative improvements in all scores when compared to the CS group. Overall, the patients who received PRP treatment had better outcomes in a longer follow-up visit (up to 1 year) than those who received CS.ConclusionsA single PRP or CS intra-articular injection is safe and improves the short-term scores of pain and the knee function in patients affected by mild to moderate symptomatic knee OA (with no significant differences between the groups). PRP demonstrated a statistically significant improvement over CS in a 1-year follow-up. This study was registered at ISRCTN with the ID ISRCTN46024618.

Intraarticular corticosteroid injections in the management of osteoarthritis knee

Objective:- The aim of the study was to assess therapeutic efficacy, adverse events and patient satisfaction of intraarticular (IA) corticosteroid injections for knee osteoarthritis (OA).&#x0D; Methods:- Thirty-two (96) patients with OA of the knee participated in the present study. The inclusion criteria included (1) Resting visual analog scale pain &gt;50 mm (2) Radiographic evidence for osteoarthritis (as per Kellgren-Lawrence scale) plus; age ≥50yrs, morning stiffness ≤ 30 min and crepitus on motion. Baseline Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) and visual analogue score (VAS) were documented. Patients received intra-articular injections of triamcinolone acetonide 40 mg in the affected knee. The patients were reviewed at 1 weeks, 4 weeks and 8 weeks post-injection with final analysis at 3 months. Use of over the counter analgesia in the form of acetaminophen was allowed for concomitant analgesia.&#x0D; Results:- Ninety-six patients (male =45, female=51) with mean age of 50±5 years (range 45-55); duration of symptoms 5.7 ± 0.5 years and mean body mass index (BMI) 29.4kg/m2 were available at final follow-up. The VAS scores at baseline were:- at rest=71 and after 30 meter walk=80 and improved to 35 and 40, respectively. Improvement in pain and disability based on the WOMAC scores were significant. The overall efficacy “Knee Society Score” was judged as excellent in 56.25%, satisfactory in 21.87%, fair in 18.75%, and poor in 3.12%. The beneficial effects stayed till 4-6 weeks.&#x0D; Conclusion:- Intra-articular steroid injections for knee OA is safe and effective. The symptomatic relief is prompt, particularly in presence of inflammation (Effusion/synovitis). Proper patient selection and aseptic precautions yield satisfactory results. The need for concomitant analgesia is reduced.

Intra-articular injection of triamcinolone acetonide in a sustained release polyesteramide formulation shows prolonged anti-inflammatory efficacy in a rat model

Intra-articular injection of triamcinolone acetonide in a sustained release polyesteramide formulation shows prolonged anti-inflammatory efficacy in a rat model

Intra-articular injection of triamcinolone acetonide releasing biomaterial microspheres inhibits pain and inflammation in an acute arthritis model

Inflammation of the synovium and joint capsule is a main driver of pain in an osteoarthritic (OA) joint. Triamcinolone acetonide (TAA) is a classical corticosteroid that reduces synovitis and alleviates pain, albeit transiently. Biomaterial-based local TAA release may prolong the suppression of pain without the need for multiple injections. Polylactic-co-glycolic acid (PLGA) formulations of TAA prolong OA pain relief to a limited extent. A novel polyesteramide (PEA) microsphere platform allows for extended release in the OA joint for over 3 months. To evaluate their effect on pain and inflammation, TAA-loaded microspheres were intra-articularly delivered to the knee joint in a rat model of acute arthritis induced by intra-articular injection of streptococcal cell wall peptidoglycan-polysaccharide (PGPS) and subsequent flare-ups by intravenous PGPS injections. PEA-loaded microspheres were benchmarked with TAA-loaded PLGA microspheres and bolus TAA injection. TAA treatments were injected intra-articularly before the first induced flare-up. TAA-loaded PEA and PLGA microspheres reduced joint swelling and signs of pain-like behavior over the entire study period, as assessed by weight bearing and referred mechanical hypersensitivity, whereas bolus suspension was effective for a shorter time period. TAA-loaded PEA microspheres reduced lameness to a greater extent than TAA-loaded PLGA microspheres. In conclusion, a single intra-articular injection of TAA-loaded PEA microspheres reduced joint swelling and induced longer pain relief compared to bolus injection. Hence relief of inflammation and pain by PEA-based delivery of TAA may prove to be effective and durable.

Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study

Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P < 0.05). In the group that did not receive intra-articular injections, no significant changes were observed in CHR, RCDR and RRA over a mean follow-up period of 8 years. No abnormalities were observed in subcutaneous tissue. Conclusions: Overall, >90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.

Comparison of high- and low-dose intra-articular triamcinolone acetonide injection for treatment of primary shoulder stiffness: a prospective randomized trial

Intra-articular corticosteroid injection has a proven effect for shoulder stiffness, yet the optimal dose is still controversial. The purpose of the study was to compare the outcomes of intra-articular triamcinolone acetonide injection at 2 different doses in patients with shoulder stiffness. Intra-articular injection of 40 mg (group I, n = 76) or 20 mg (group II, n = 71) of triamcinolone acetonide was performed in patients with shoulder stiffness. The outcome measures including range of motion (ROM), American Shoulder and Elbow Surgeons score, visual analog scale for pain score, and Simple Shoulder Test score were evaluated at 3 weeks, 6 weeks, 12 weeks, 6 months, 12 months, and the last follow-up. Among the patients with controlled diabetes, the levels of blood glucose, fructosamine, and HbA1c were measured to evaluate systemic serologic changes induced by injection. There were significant improvements in ROM and functional scores in both groups at the last follow-up. However, there was no significant difference between the groups in any of the parameters at each time point. None of the diabetic patients in either group had a significant increase in blood glucose, fructosamine, and HbA1c levels compared with levels before injection. However, those in group I showed significantly higher blood glucose levels at 6 weeks after injection compared with those in group II (P = .01). Intra-articular injection of triamcinolone is an effective method for improving ROM and clinical function in patients with shoulder stiffness. However, there was no significant difference in regard to different doses. In diabetic patients, a lower dose is recommended as short-term glucose levels may increase with a high dose of corticosteroid.

Simultaneous Treatment with Subcutaneous Injection of Golimumab and Intra-articular Injection of Triamcinolone Acetonide (K-Method) in Patients with Rheumatoid Arthritis Undergoing Switching of Biologics: Retrospective Case-Control Study.

BACKGROUNDTight control of severe rheumatoid arthritis (RA) in patients with high disease activity, even when using biologics, is sometimes difficult using a treat-to-target strategy. Switching from one biologic to another is associated with lower efficacy than that in treatment-naive cases. We developed the K-method that involves simultaneous treatment with golimumab and intra-articular joint injection of triamcinolone acetonide (TA) in patients undergoing switching of biologics. We performed this retrospective case–control study to investigate the efficacy of achieving an immediate treatment response using the K-method.METHODSThis study involved 20 patients with RA (control group, 10 patients; K-method group, 10 patients). Patients in the control group were switched to golimumab from other biologics without intra-articular injection of TA. The K-method involved injection of 1 mL of TA (40 mg/mL) and 2 mL of 1% lidocaine hydrochloride into swollen or painful joints on the same day as golimumab treatment. A quick response one day after treatment was compared between the two groups according to the disease activity score 28 based on C-reactive protein (DAS28 CRP), clinical disease activity index (CDAI), simplified disease activity index (SDAI), European League Against Rheumatism (EULAR) response, and remission rate. These parameters were investigated for 24 weeks.RESULTSThe K-method group showed significant improvements in DAS28 CRP, CDAI, and SDAI at one day, 12 weeks, and 24 weeks compared with the control group. The number of swollen and tender joints and the patient and doctor global visual analog scale scores were also significantly different between the two groups. The remission rates based on DAS28 CRP were 30% at one day, 50% at 12 weeks, and 60% at 24 weeks in the K-method group. The EULAR good/moderate response rates were 80% at one day, 90% at 12 weeks, and 90% at 24 weeks in the K-method group; however, these rates were only 10%, 40%, and 40%, respectively, in the control group. No adverse events occurred in either group.CONCLUSIONSimultaneous treatment with biologics and intra-articular injection of TA is useful for cases involving switching of biologics for RA. This strategy is safe and practical for RA treatment.

Differences in structural and pain phenotypes in the sodium monoiodoacetate and meniscal transection models of osteoarthritis

SummaryObjectivesTo characterize differences in joint pathology and pain behavior between two rat models of osteoarthritis (OA) in order to inform selection of animal models for interventional studies.MethodKnee OA was induced in Sprague Dawley rats by either meniscal transection (MNX) or intra-articular injection of monosodium iodoacetate (MIA). Controls were subjected to sham surgery or saline-injection. In a separate experiment, a single intra-articular injection of triamcinolone acetonide was administered 14 days after MNX or MIA arthritis induction. Pain behavior and joint pathology were quantified.ResultsBoth models displayed synovial inflammation, chondropathy and osteophytosis. Chondropathy scores increased with time similarly in the two models. Inflammation and osteophyte scores were greater in MNX model compared to the MIA model. At day 49, the MNX model exhibited a greater number of channels crossing the osteochondral junction compared to all other groups. The MNX model exhibited greater weight bearing asymmetry compared to the MIA model, whereas the MIA model displayed more consistent hindpaw allodynia. Triamcinolone attenuated weight bearing asymmetry and distal allodynia to control levels in the MNX model, but distal allodynia was unaltered in the MIA model.ConclusionsThe comparison of the two models of OA in rats, using identical assessment tools has demonstrated that although both models display features of OA, there are differences between the models which may represent different aspects of human OA. Thus, model selection should be based on the pathological aspects of OA under investigation.