steroids

Corticosteroids

Local corticosteroid injections

Corticosteroids are injected locally for an anti-inflammatory effect. In inflammatory conditions of the joints, particularly in rheumatoid arthritis, they are given by intra-articular injection to relieve pain, increase mobility, and reduce deformity in one or a few joints; they can also provide symptomatic relief while waiting for disease-modifying antirheumatic drugs (DMARDs) to take effect. Full aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site.

Smaller amounts of corticosteroids may also be injected directly into soft tissues for the relief of inflammation in conditions such as tennis or golfer’s elbow or compression neuropathies. In tendinitis, injections should be made into the tendon sheath and not directly into the tendon (due to the absence of a true tendon sheath and a high risk of rupture, the Achilles tendon should not be injected).

Hydrocortisone acetate or one of the synthetic analogues is generally used for local injection. Intra-articular corticosteroid injections can cause flushing and may affect the hyaline cartilage. Each joint should not usually be treated more than 4 times in one year.

At Asclepius Medical we use either Kenalog (Triamcinolone Acetate) or Depo-Medrone (Methylprednisolone) as our treatments of choice.

Possible Side Effects of Corticosteroids

Mineralocorticoid side effects

hypertension
sodium retention
water retention
potassium loss
calcium loss

Mineralocorticoid side effects are most marked with fludrocortisone, but are significant with hydrocortisone, corticotropin, and tetracosactide. Mineralocorticoid actions are negligible with the high potency glucocorticoids, betamethasone and dexamethasone, and occur only slightly with methylprednisolone, prednisolone, and triamcinolone.

Glucocorticoid side effects

diabetes
osteoporosis, which is a danger, particularly in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae
in addition high doses are associated with avascular necrosis of the femoral head
muscle wasting (proximal myopathy) can also occur
corticosteroid therapy is also weakly linked with peptic ulceration and perforation
psychiatric reactions may also occur