Intra-articular Methylprednisolone Acetate Research Articles

Pulmonary response of severely asthmatic horses after intra-articular administration of methylprednisolone.

Intra-articular (IA) administration of corticosteroids is performed routinely in equine practice. The lung function of severe asthmatic horses has recently been shown to be improved by IA triamcinolone acetonide (TA). We therefore hypothesised that IA methylprednisolone acetate (MPA), another commonly used corticosteroids, would also decrease the airway obstruction in severe asthmatic horses. To compare the effects of intra-articular (IA) and intramuscular (IM) methylprednisolone acetate (MPA) administration on lung function and serum cortisol levels in horses with severe asthma. Randomised and controlled experiments on severe asthmatic research animals. Severe asthmatic horses in exacerbation were administered 200mg of MPA either intramuscularly (n=6) or via intra-articular injections in the tarsocrural joints (n=6; 100mg/joint). Serum cortisol concentration and pulmonary function was measured for 8days. A significant decrease in pulmonary resistance in the IA group (P=.003, mean diff 1.14) on day 1 in comparison with baseline was observed. A significant decrease from baseline was also observed on serum cortisol values in the IA group 6hours after injection (P=.001, mean diff 44.5), and at day 1 (P=.003, mean diff 45.1). Joint health was not evaluated in the current study and the physiological response of the severe asthmatic horses might deviate from that of the milder forms of asthma. MPA IA administration improves the lung function of severe asthmatic horses. However, this effect was mild and of a short duration.

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

Comparison of efficacy of intraarticular polyacrylamide hydrogel and methylprednisolone acetate in patients with knee osteoarthritis

Purpose: The aim of this study was to compare and evaluate the efficacy of intraarticular methylprednisolone acetate and an intra-articular polyacrylamide hydrogel in patients with different stages of knee osteoarthritis. Materials and Methods: Patients with symptomatic knee osteoarthritis and history of failed pharmacotherapy or physiotherapy interventions were included in this study. The first 64 consecutive patients got intra-articular polyacrylamide hydrogel, the latter 79 consecutive patients got intra-articular methylprednisolone acetate. Patients were evaluated by WOMAC score and self-assessment questions. Results: There was no statistically significance difference between groups when WOMAC scores and answers of self-assessment questions were compared. Conclusion: Intra-articular use of polyacrylamide hydrogel was not superior to methylprednisolone acetate, for patients with knee osteoarthritis.

Posttraumatic Osteoarthritis Development and Progression in an Ovine Model of Partial Anterior Cruciate Ligament Transection and Effect of Repeated Intra-articular Methylprednisolone Acetate Injections on Early Disease

Background: Partial anterior cruciate ligament (p-ACL) ruptures are a common injury of athletes. However, few preclinical models have investigated the natural history and treatment of p-ACL injuries. Purpose: To (1) demonstrate whether a controlled p-ACL injury model (anteromedial band transection) develops progressive gross morphological and histological posttraumatic osteoarthritis (PTOA)–like changes at 20 and 40 weeks after the injury and (2) investigate the efficacy of repeated (0, 5, 10, and 15 weeks) intra-articular injections of methylprednisolone acetate (MPA; 80 mg/mL) in the mitigation of potential PTOA-like changes after p-ACL transection. Study Design: Controlled laboratory study. Methods: Twenty-one 3- to 5-year-old female Suffolk-cross sheep were allocated to 4 groups: (1) nonoperative controls (n = 5), (2) 20 weeks after p-ACL transection (n = 5), (3) 40 weeks after p-ACL transection (n = 6), and (4) 20 weeks after p-ACL transection + MPA (n = 5). Gross morphological grading and histological analyses were conducted. mRNA expression levels for inflammatory, degradative, and structural molecules were assessed. Results: p-ACL transection led to significantly more combined gross damage (P = .008) and significant aggregate histological damage (P = .009) at 40 weeks after p-ACL transection than the nonoperative controls, and damage was progressive over time. Macroscopically, MPA appeared to slightly mitigate gross damage at 20 weeks after p-ACL transection in some animals. However, microscopic analysis revealed that repeated MPA injections after p-ACL transection led to significant loss in proteoglycan content compared with the nonoperative controls and 20 weeks after p-ACL transection (P = .008 and P = .008, respectively). Conclusion: p-ACL transection led to significant gross and histological damage by 40 weeks, which was progressive over time. Multiple repeated MPA injections were not appropriate to mitigate injury-related damage in a p-ACL transection ovine model as significant proteoglycan loss was observed in MPA-treated knees. Clinical Relevance: A p-ACL injury leads to slow and progressive PTOA-like joint damage, and multiple repeated injections of glucocorticoids may be detrimental to the knee joint in the long term.

Therapeutic Review of Methylprednisolone Acetate Intra-Articular Injection in the Management of Osteoarthritis of the Knee - Part 2: Clinical and Procedural Considerations.

The use of an intra-articular methylprednisolone acetate (MPA) injection has been shown to have benefits for symptoms of knee osteoarthritis (OA). However, considerations beyond drug efficacy can influence the appropriateness, clinical effectiveness and potential harm of an injection. A review of research evidence and published literature on clinical and procedural factors influencing the effectiveness and safety of a knee injection has been undertaken. Factors include dose, frequency, contraindications, precautions, drug interactions, side-effects, and procedural and patient-related considerations. An evaluation of evidence indicated that a 40 mg dose provides clinical benefit. No strong predictors of response were evident, with the exception of pain severity. Additional benefit for outcomes from higher doses, local anaesthetic, ultrasound guidance or particular anatomical approaches is yet to be demonstrated. Evidence for dose- and duration-related detrimental effects suggests judicious use and frequency. The evaluation showed that there are a number of contraindications and precautions arising from the drug pharmacology, concurrent medications, comorbidities and adverse events which need consideration and monitoring. There was limited safety evidence concerning anticoagulation. The review found that specialist guidance and limited evidence suggests that injection safety concerning warfarin may be enhanced by ensuring that the international normalized ratio level is within therapeutic range. However, the risk-benefit evaluation concerning non vitamin K antagonist oral anticoagulants remains challenging. Although there is published guidance, a lack of clinical studies, safety evidence and reversibility advocates caution. Overall, the review indicates that injection decisions and procedures need an individualized approach and supporting evidence is limited in many areas. Evaluation and discussion of benefits and risks, peri-procedural and post-injection management, and tailoring to the context and individuals' preferences are important in optimizing the benefits and safety of a knee injection.

Therapeutic Review of Methylprednisolone Acetate Intra-Articular Injection in the Management of Osteoarthritis of the Knee - Part 1: Clinical Effectiveness.

Intra-articular (IA) corticosteroid injections are a common approach in the management of osteoarthritis (OA) of the knee. The effectiveness of injections and particular injection products is often discussed and debated in clinical arenas. The following therapeutic review examines the evidence for intra-articular methylprednisolone acetate (MPA) injections in the management of OA knee. A review of research evidence, published guidelines and clinical literature was undertaken following an electronic database and relevant literature search. The review found that there is limited evidence which indicates that a single dose intra-articular MPA injection can provide short to medium term benefits for pain, with less evidence for beneficial effects on function or stiffness. There is heterogeneity across studies and until recently, most studies had only short to medium term follow-up periods, thus limiting the evidence available on longer term benefit. There was also evidence indicating equivalent overall efficacy of MPA to that of other corticosteroid products. Most guideline recommendations concerning IA injections for OA knee have drawn on evidence from pooled data for several corticosteroid products. The review also found there was limited reporting of the incidence of adverse events in most studies. Overall, MPA shows efficacy for symptom relief in OA knee. At an individual management level, evidence for a limited duration of effect needs consideration in injections decisions. Furthermore, consensus across clinical guidelines suggests that the management of OA knee should be individualized to a person's clinical history, degree of disability, risk factors, quality of life and personal preferences, whereby injecting involves a shared decision and forms part of a multimodal approach. Copyright © 2016 John Wiley & Sons Ltd.

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.

The effect of intra-articular methylprednisolone acetate and exercise on equine carpal subchondral and cancellous bone microhardness.

Dorsal carpal osteochondral injury is a major cause of lameness in horses undergoing high intensity training. Intra-articular corticosteroid treatment is used commonly to manage exercise-associated articular pain, but its use remains highly controversial in the equine athlete. This project, therefore, aimed to compare the mechanical properties of intra-articular MPA and diluent-treated middle carpal subchondral and cancellous bone in horses undergoing a short-term treadmill exercise programme. It was hypothesised that subchondral and cancellous bone mechanical properties are influenced by intra-articular administration of methylprednisolone acetate (MPA). Eight 2-year-old female horses had MPA or diluent administered into contralateral middle carpal joints at 14 day intervals, for a total of 4 treatments per horse. Horses underwent a standard treadmill exercise protocol until euthanasia (Day 70). Standard sites were located on the dorsal aspect of third, radial and intermediate carpal bones. Osteochondral samples from each test site were divided into subchondral bone and cancellous bone portions. These were dried, resin-embedded and gold-coated. Microhardness measurements were obtained at each test site. No significant effect of intra-articular treatment was detected. At each site, cancellous bone trabecular struts had an 18-19% higher microhardness value than the overlying subchondral bone. These findings indicate that intra-articular administration of MPA at this dose has no effect on subchondral or cancellous bone adaptation to short-term exercise and, therefore, on the propensity of carpal bones to injury. Further investigation into the calcified cartilage layer, effect of different corticosteroid preparations and diffusion of medication are required.

Acute synovitis and intra-articular methylprednisolone acetate in ponies

Objective: To determine how acute synovitis, with and without intra-articular methylprednisolone acetate (MPA), affect synthesis of proteoglycan, total protein, and collagen in articular cartilage and total protein synthesis in synovial membrane.Design: Synovitis was induced in 10 ponies by the injection of 0.5 ng lipopolysaccharide (LPS) into the left radiocarpal and midcarpal joints every 2 days for a total of four treatments. Synovitis was documented by clinical examination and synovial fluid analyses. Two days before euthanasia, MPA (0.1 mg/kg) was injected with the last dose of LPS into both the left and right radiocarpal and midcarpal joints of five of these ponies. Proteoglycan synthesis in articular cartilage explants from these joints was measured by incorporation of sodium [35S]sulfate. The size of the proteoglycan monomers and their aggregation with hyaluronan was assessed by size-exclusion chromatography. Protein synthesis in articular cartilage was measured by incorporation of [3H]proline and collagen synthesis by conversion of [3H]proline into [3H]hydroxyproline. Protein synthesis was measured in synovial membrane explants by incorporation of [35S]methionine.Results: Ponies developed carpal effusion and mild lameness accompanied by increased total nucleated cell count and total solids in synovial fluid in response to the LPS injections. Moderate to severe synovial membrane proliferation and inflammation were observed histopathologically in joints injected with LPS but no consistent light-microscopical changes were observed in the articular cartilage from these joints. Intra-articular MPA alone was associated with decreased proteoglycan synthesis and increased protein and collagen synthesis in the cartilage explants. Total protein synthesis by synovial membrane was also increased by MPA alone. In contrast, no differences in protein or proteoglycan synthesis were observed in explants from the joints with synovitis, with or without intra-articular MPA. Treatment with MPA, LPS, and LPS/MPA did not alter proteoglycan aggregate size, but LPS-induced synovitis resulted in an increase in the second largest population of monomers. MPA increased the synthesis of small proteoglycan monomers.Conclusion: Based on the methods used, acute synovitis prevented changes induced by intra-articular MPA alone. Results suggested that the effect of intra-articular MPA on joint metabolism was different between inflamed and normal joints. Experimental studies must consider the effect of inflammation, as well as the potential to introducein vitroculture artifacts when investigating the effect of intra-articular corticosteroids on chondrocyte function.

The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse

Introduction: Intra-articular corticosteroids are widely used as anti-inflammatory agents for symptomatic management of arthritis, but their administration with concurrent exercise remains controversial. Biochemical and morphologic analysis of treated cartilage has revealed conflicting results, but previous biomechanical assessment has not been undertaken.Objective: To compare the biomechanical properties of intra-articular methylprednisolone acetate (MPA) and diluent treated cartilage in treadmill exercised horses.Methods: Eight 2-year-old female horses had MPA or diluent administered into contralateral middle carpal joints at 14 day intervals for a total of four treatments per horse. Horses underwent a standard treadmill exercise protocol until euthanasia (day 70). Standard sites were tested on the third, radial and intermediate carpal bones using an automated indentation apparatus to obtain the creep and recovery behavior of the articular cartilage. Using previously validated biphasic creep indentation methodology, aggregate modulus, Poisson's ratio, permeability, shear modulus, thickness, creep and recovery equilibrium times and percent recovery were obtained at each site. Results were analyzed using ANOVA and multiple comparisons of the means (P<0.05).Results: Cartilage intrinsic material properties and thickness demonstrated significant differences between MPA and diluent treated joints. Diluent treated cartilage had a 97% increase in compressive stiffness modulus (P=0.0001) was 121% more permeable (P=0.0001), had 88% increase in shear modulus (P=0.0001), and was 24% thicker (P=0.0001) than MPA treated articular cartilage.Conclusions: The findings indicate that repetitive intra-articular administration of MPA to exercising horses alters the mechanical integrity of articular cartilage, which could lead to early cartilage degeneration.

Hypothalamic-pituitary-adrenal (HPA) axis function in patients receiving long-term intra-articular corticosteroids.

The hypothalamic-pituitary-adrenal (HPA) axis function of eight patients with rheumatoid arthritis receiving regular intra-articular methyl prednisolone acetate was studied. Tests of the HPA axis 5-7 weeks after the last injection revealed suppression in two patients. Some patients receiving intra-articular corticosteroids may therefore have abnormal responses to stress.