Corticosteroids are used to control inflammation in arthritis and other inflammatory conditions. Corticosteroids can be injected directly into inflamed tissues, or they can be delivered to the whole body via oral preparations, intravenous injections, or intramuscular injections. Steroid injections may provide significant relief to patients with arthritis or musculoskeletal conditions. For patients with rheumatoid arthritis , the injections are typically offered when only one or two joints display active synovitis . The goal of treatment is to quell symptoms of a flare or to enable slower-acting drugs, such as methotrexate or Plaquenil , time to work. For example, in early rheumatoid arthritis, study results revealed that a combination of DMARDs and intra-articular steroids is significantly better than DMARDs alone.
Early trials of intra-articular corticosteroids showed equal systemic absorption of methylprednisolone in patients with rheumatic and osteoarthritic hands 42 and knees. 43 This suggests that steroid pharmacokinetics, rather than disease-related factors, should guide steroid selection. A recent review by the National Health Service of the United Kingdom 44 recommends triamcino-lone and methylprednisolone as preferred agents for injection of large joints (., knee). For smaller joints (., finger), either hydrocortisone or methylprednisolone (Hydeltrasol, brand no longer available in the United States) is recommended. Tables 5 and 6 45 compare commonly available steroid preparations.
Intramuscular Injection: Provides an extended duration of therapeutic effect and fewer side effects of the kind associated with oral corticosteroid therapy, particularly gastro-intestinal reactions such as peptic ulceration. Studies indicate that, following a single intramuscular dose of 80 mg triamcinolone acetonide, adrenal suppression occurs within 24 - 48 hours and then gradually returns to normal, usually in approximately three weeks. This finding correlates closely with the extended duration of therapeutic action of triamcinolone acetonide.