Intra-articular
corticosteroid injections are widely used in aseptic
arthritis, most often as a supplement to systemic anti-inflammatory
therapy. Suppression of local joint
inflammation by
corticosteroids is rapid and pronounced, and may be achieved with only minor systemic effects; however, this suppression is usually only temporary. The original compound
hydrocortisone acetate has been replaced by longer-acting preparations such as
methylprednisolone acetate,
triamcinolone acetonide and
triamcinolone hexacetonide. In controlled studies,
triamcinolone hexacetonide has proved most effective, providing clinical effect for a mean period up to several months. However, this compound frequently causes local tissue
necrosis when injected outside a synovial cavity, and it should be used only by experienced clinicians. Indications for intra-articular
corticosteroids include mono- or
oligoarthritis in
rheumatoid arthritis and other aseptic inflammatory
joint diseases. Intra-articular
corticosteroids are also used in
osteoarthritis, but in controlled studies the effect is brief and transient. A number of potential adverse effects of intra-articular
corticosteroids stress the importance of their judicious use. The risk of cartilage damage and progressive joint destruction is a controversial issue. The results of animal studies are ambiguous. Despite case reports of severe
arthropathy, most studies on humans suggest that, when used appropriately, the beneficial effects of intra-articular
corticosteroids exceed the harmful effects. Nevertheless, it is recommended that
corticosteroid injections into the same joint should be limited, for instance to 1 injection every 6 weeks and no more than 3 to 4 in 1 year. Prior to intra-articular
corticosteroid injections the indications and
contraindications should always be considered. In particular,
infection should be ruled out. Strict aseptic technique is essential to avoid iatrogenic
septic arthritis. Correct intra-articular
corticosteroid therapy is of great clinical value in the management of aseptic arthritic disease.