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Intra-articular methylprednisolone acetate injection at the knee joint and the hypothalamic–pituitary–adrenal axis: a randomized controlled study
- 作者:George Habib (4) (5)
Adel Jabbour (1) Suheil Artul (2) Geries Hakim (3)
- 关键词:Adrenal insufficiency ; Adrenocorticotropin hormone stimulation test ; Corticosteroids ; Cortisol ; Intra ; articular ; Knee osteoarthritis ; Methylprednisolone acetate
- 刊名:Clinical Rheumatology
- 出版年:2014
- 出版时间:January 2014
- 年:2014
- 卷:33
- 期:1
- 页码:99-103
- 全文大小:130 KB
- 作者单位:George Habib (4) (5)
Adel Jabbour (1) Suheil Artul (2) Geries Hakim (3)
4. Rheumatology Clinic, Nazareth Hospital, P.O. Box 11, Nazareth, 16100, Israel 5. Department of Medicine, Carmel Medical Center, Haifa, Israel 1. Central Laboratory, Nazareth Hospital, Nazareth, Israel 2. Department of Radiology, Nazareth Hospital, Nazareth, Israel 3. Orthopedic Department, Nazareth Hospital, Nazareth, Israel
- ISSN:1434-9949
文摘
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 80?mg of MPA at the knee joint and group 2 patients had an intra-articular injection (IAI) of 6?ml (60?mg) 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 (1?μg) adrenocorticotropin hormone (ACTH) stimulation test. Demographic, clinical, laboratory, and radiologic variables were documented in all patients. Both criteria of <7?μg/dl increase in the serum cortisol level and absolute levels of <18?μg/dl 30?min 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--.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 80?mg 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.
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