Intra-articular Injection Of Methylprednisolone Acetate Research Articles

Short Term Effectiveness of Intraarticular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in A Tertiary Care Hospital

Objective: To determine the effectiveness of intraarticular injection of methylprednisolone acetate in subacromial impingement syndrome. Study Design: Descriptive Case Series Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and MTI, Hayatabad Medical Complex Peshawar for one year duration from February 2020 to February 2021. Methods: Total 100 patients of newly diagnosed subacromial impingement syndrome were enrolled in this study. Patients were aged between 20-60 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients did not receive any treatment before were included. Effectiveness of intraarticular injection of methyl prednisolone acetate was measured by using visual analogue scale (VAS) for pain intensity from 0 to 10 by VAS score after 4 weeks.Completedata was analyzed by SPSS 22.0 version. Results: Mean age of the patients was 38.14±7.44 years with mean BMI 25.64±18.9kg/m2. Among 100 cases, 75 (75%) patients were males and 25 (25%) were females. Diabetic patients were 25 (25%) and 14 (14%) patients were gout among all cases. Mean VAS score before treatment was 6.14±4.84 and after treatment VAS score was reduced to 4.41± 3.64. After follow up of 4 weeks VAS score was decreased to 1.11±3.65. Satisfaction among patients were 90 (90%). Conclusion: We concluded in this study that for the treatment of subacromial impingement syndrome, intraarticularinjection of methylprednisolone acetate was effective and useful. It was also observed that VAS score among patients were reduced significantly with should pain. Keywords: Intra articular methylprednisolone injection, Subacromial impingement syndrome, Effectiveness, Visual analogue scale

Efficacy of intra-articular injection of methylprednisolone in patients with osteoarthritis of the knee in southern district of India

Background: Osteoarthritis (OA) is a most common form of arthritis wherein chronic progressive degenerative changes occur in the articular cartilage of the joint which leads to restriction of joint function and poor life quality and it is globally prevalent causing pain and functional disability. Intra-articular corticosteroids are usually administered to candidates who do not show symptomatic relief to conservative line of management. Aims and Objectives: The objective of the study is to assess the efficacy of intra-articular injection of methylprednisolone acetate in patients with OA of the knee. Materials and Methods: Patients of all age and gender diagnosed with primary OA of knee with visual analog scale (VAS) pain score seven and more than seven with X-ray evidence of osteoarthropathy of knee with Kellgren Lawrence classification one-three, patients not satisfied with anti-inflammatory drugs and physiotherapy were included in the study. Study participants were asked for self-assessment of pain and mark on the VAS and interpretation of scoring was statistically analyzed. Results: Thirty study participants were enrolled for the study among them, the male and female were 56.67% and 43.33%, respectively. The mean age of the study participants was 59.2 ± 11.79 years. The mean VAS pain score before intra-articular methylprednisolone acetate was 9.37 ± 0.81 and there was gradual decrease in pain score after intra-articular injection over time in 2, 4, 8, 12, and 24 weeks. Conclusion: Intra-articular methylprednisolone acetate had revealed good efficacy in patients with OA knee with chronic pain without adverse effects.

Intra articular methylprednisolone acetate injection efficacy in the treatment of primary knee osteoarthritis at Hue Central Hospital and Hospital of Hue University of Medicine and Pharmacy

Introduction/Background: Osteoarthritis is still an incurable disease, the current treatment is to reduce clinical symptoms. The intra articular glucocorticoid injection in knee osteoarthritis makes the inflammatory process self-limiting and improves pain symptom. Objectives: To evaluate the efficacy and safety of intra articular methylprednisolone acetate injection in treatment of primary knee osteoarthritis. Materials and Methods: Prospective descriptive study of 88 knee joints (34 joints in study group, 54 joints in control group) was diagnosed with primary osteoarthritis according to the American College of Rheumatology (ACR) classification criteria and in Kellgen & Lawrence grade II, III. The patient was assessed about clinical features, subclinical features and the VAS score, Lequesne index at the initial of the study and 7 days later. Results: The analgesic effect was higher in the group of intra articular methylprednisolon injection with statistically significant difference (∆VAS of the study group and the control group were 38.65 ± 9.25; 25.11 ± 9.26, respectively, with p < 0.05). The improving of knee function was higher in the group of intra articular methylprednisolon injection with statistically significant difference (∆Lequesne of the study group and the control group were 7.00 (5.00 – 8.00); 4.00 (3.00 – 5.00), respectively, with p < 0.05). The incidence of complications in the study group was 1/34 (2.94%) with post – injection pain. The improvement of VAS is better in patient with severe pain than those with moderate pain (p < 0.05) and correlated to the initial value of Lequesne (r2 = 0,162, respectively, with p < 0.05). The improvement of Lequesne correlated to the joint fluid thickness in ultrasound (r2 = 0.102, p < 0.05). There is no relation between efficacy of treatment and site of knee joint, radiology stage and synovial membrane thickness (p > 0.05). Conclusions: The intra articular methylprednisolone acetate injection in treatment of primary knee osteoarthritis is a safe treatment and has significant, clearly effect in pain relief and physical function improving after 7 days. The improvement of VAS is better in the patient with higher initial value of VAS, Lequesne and the improvement of Lequesne is better in the patients with more synovial thickness in ultrasound. Key words: Knee osteoarthritis, intraarticular injection, methylprednisolon acetate

The impact of intra-articular methylprednisolone acetate injection on fructosamine levels in diabetic patients with osteoarthritis of the knee, a case-control study.

Fructosamine is a glycated protein that reflects blood glucose control over the last 2-3weeks. There are no studies that address the impact of intra-articular injection (IAI) of methylprednisolone acetate (MPA) on fructosamine levels among patients with type-2 diabetes and osteoarthritis of the knee (OAK). Non-selected patients attending the rheumatology or orthopedic clinic with type-2 diabetes and painful OAK, who failed non-steroidal anti-inflammatory drugs (NSAIDS) and physical therapy, were asked to participate in our study. After consent blood tests were drown for fructosamine, hemoglobin A1c (HbA1c) level, complete blood count, lipid profile, serum albumin, serum protein, c-reactive protein, and erythrocyte sedimentation rate. Demographic and different clinical parameters were also documented. Immediately after that, patients had IAI of 80mg of MPA at the knee joint (group 1). Two to three weeks later, the same blood tests were repeated (except for HbA1c). Age- and sex-matched group of patients with type-2 diabetes and painful OAK attending the same clinics, but who were managed by NSAIDS were asked to participate as a control group (group 2) and had the same evaluation at enrollment and 2-3weeks later, after consent. Eighteen patients from either group completed the study. Mean fructosamine level in group 1 patients was 263.7 ± 31.8mg% prior to the IAI vs. 274.6 ± 39.3mg% (p = 0.035), 2-3weeks later, while mean fructosamine level in the control group (group 2) at enrollments was 274.2 ± 31.2mg% vs. 269 ± 30.2mg%, p = 0.509, 2-3weeks later. There was no significant change in any other parameter tested at enrollment in either group, compared to those obtained 2-3weeks afterwards. Body mass index was on the edge of significance as a predictor for a significant change in fructosamine level in group 1 patients. IAI of 80mg of MPA in patients with type-2 diabetes and OAK had resulted in a significant, though mild increase in fructosamine levels 2-3weeks later.

Intra-articular methylprednisolone acetate injection at the knee joint and the hypothalamic–pituitary–adrenal axis: a randomized controlled study

The objective of this study was to evaluate the effect of intra-articular corticosteroid injection (IACI) of methylprednisolone acetate (MPA) on the hypothalamic-pituitary-adrenal (HPA) axis in patients with osteoarthritis of the knee. Patients with symptomatic osteoarthritis of the knee who failed to respond to nonsteroidal anti-inflammatory medications and physical therapy were randomized between group 1 and group 2. Group 1 patients had an IACI of 80mg of MPA at the knee joint and group 2 patients had an intra-articular injection (IAI) of 6ml (60mg) of sodium hyaluronate (control group). Immediately prior to the IAI and on weeks 1, 2, 3, 4, and 8 following IAI, patients from both groups underwent a low-dose (1μg) adrenocorticotropin hormone (ACTH) stimulation test. Demographic, clinical, laboratory, and radiologic variables were documented in all patients. Both criteria of <7μg/dl increase in the serum cortisol level and absolute levels of <18μg/dl 30min following the ACTH stimulation test were used to define secondary adrenal insufficiency (SAI). Twenty patients were randomized in each group. In group 1, 25% of patients had SAI vs. none in group 2 (p = 0.0471). The earliest SAI was observed at week 2, and latest SAI was observed at week 4. SAI was observed at one time point, two consecutive time points, or two separate time points in the same patient. There was no correlation between SAI and any of the demographic, clinical, or laboratory variables. An IACI of 80mg MPA at the knee joint induced a transient SAI in 25% of the patients, an effect that was observed between week 2 and week 4 following the IACI.

Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee

The effect of oral or intravenous steroid treatment on glucose metabolism is well known.1 Intra-articular steroid injection (IASI) at the knee joint is a common procedure,2 however there are no...

Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients

The effect of systemic glucocorticosteroids on the metabolism of glucose is well known; however, there are no reports on the effect of intraarticular steroids on the metabolism of glucose in diabetic patients. Controlled or near controlled diabetic patients who have self-monitoring devices for home monitoring of blood glucose with shoulder pain were offered an intraarticular crystalloid steroid injection of 35 mg of methylprednisolone acetate (MPA) at the shoulder joint after failure of pharmacological and physical therapy. Patients were asked to record blood glucose levels before and 2 h after breakfast, lunch, and supper (six times a day) every other day during 1 week before the injection and during the day of the injection, the next day and every other day for 2 weeks after the injection. Fructosamine levels were obtained just before the injection and 2 weeks after the injection. Wilcoxon signed rank test was used to compare the mean glucose levels before with those after the injection. Paired t test was used to compare the mean fructosamine values after the injection with those before the injection. Eighteen patients completed the study. Fifteen had adhesive capsulitis. The mean glucose levels before injection were 165.5, 195.5, 184.6, 199.4, 182.8, and 200.7 mg% before and 2 h after breakfast, lunch, and supper, respectively. There was no significant change between the mean glucose values before and after meals after the injection compared to those before the injection, respectively, except on a few occasions only throughout the study period. Mean fructosamine level before injection was 279 micromol/l+/-49.8 compared to 275 micromol/l+/-50.9 after the injection (P=0.125). Intraarticular injection of MPA at the shoulder joint in diabetic patients with shoulder pain has no significant effect on blood glucose levels.

Systemic Contact Dermatitis Caused by Systemic Corticosteroid Use

Adelayed-type generalized skin eruption after systemic corticosteroid administration is rare. We describe a patient with systemic contact dermatitis caused by corticosteroid use. Report of a Case. A 62-year-old woman had a history of a burn treated with ointment containing hydrocortisone in 1990. No adverse effects were noted. In 1992, she was given an intra-articular injection of methylprednisolone acetate in the knee because of arthrosis. On that evening she developed erythema around the neck. In January 1994, because of sudden deafness, she was given an intravenous injection of hydrocortisone sodium phosphate, 500 mg, for 2 days, and then developed erythema on the neck, trunk, and thighs in the evening on the first day of injection. Methylprednisolone sodium succinate was substituted for the hydrocortisone. The eruption developed into a generalized rash. The methylprednisolone treatment was discontinued and the eruption resolved. She was referred to us for an evaluation of the eruption. The

Comparison of high-performance liquid chromatography with a radiometric assay for determination of the effect of intra-articular administration of corticosteroid and saline solution on synovial fluid hyaluronate concentration in horses

SUMMARY Two recently developed direct methods, radioassay—125I-labeled hyaluronic acid binding protein (125I-habp)—and high-performance liquid chromatography (halc), were used to assess and compare the concentration of hyaluronate (ha) in synovial fluid of horses. Also determined were changes in the ha concentration in an experimental treatment model involving physiologic saline solution (pss)-irrigated or methylprednisolone acetate-injected tarsocrural joints of clinically normal horses. Serum ha concentration was determined simultaneously, using the 125I-habp assay. Synovial fluid ha concentration values obtained by use of the hplc method were approximately double the values obtained by use of 125I-habp assay. Correlation (r = 0.819) between the 2 methods was highly significant (P &lt; 0.001; linear regression analysis) for all samples studied and for various experimental subgroups. When pure ha standards were used, correlation between the 2 methods was close to 1 (r = 0.965; P &lt; 0.001), with higher values obtained by use of the 125I-habp assay. It is suggested that the ha binding protein derived from endogenous cartilage proteoglycan interferes with the 125I-habp assay on synovial fluid, resulting in excessively low values, compared with those obtained using the hplc procedure. Intra-articular injection of methylprednisolone acetate significantly (P &lt; 0.01) increased synovial fluid ha concentration at 24 hours after injection. Increase was also detected after pss irrigation, but owing to wide intersubject variation, this increase was not significant. The hplc procedure, which provides simultaneous information about the concentration and degree of polymerization of ha, is recommended for the study of synovial fluid, whereas the 125I-habp assay is more suitable for serum ha analysis.

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

Twenty-one patients with rheumatoid arthritis received injections of either 40 mg or 80 mg of methylprednisolone acetate into one or both knee joints. Serum methylprednisolone and cortisol levels were measured at intervals up to 1 week following injection. Peak serum levels of methylprednisolone were reached at between 2 and 12 hours following injection, and increasing the injected dose resulted in correspondingly higher serum levels. Injection of 80 mg of methylprednisolone as 40 mg into each knee produced consistently higher peak serum levels than when given as a single intra-articular injection. Serum cortisol levels were substantially suppressed for up to 1 week, and this effect was seen at all dose levels.