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Tender shins and steroid therapy
1University of Toronto Rheumatic Disease Unit, ON, Canada.
The Journal of Rheumatology
|October 1, 1991
Summary
Chronic steroid therapy increases shin tenderness, with a lower pain threshold observed in treated patients compared to controls. General tenderness increases were also noted in patients with lupus and in women.
Area of Science:
- Rheumatology
- Pharmacology
- Pain Medicine
Background:
- Chronic steroid therapy is associated with various side effects.
- Shin tenderness has been anecdotally reported in patients on long-term corticosteroids.
- Objective quantification of this tenderness is lacking.
Purpose of the Study:
- To objectively quantify shin tenderness in patients receiving chronic steroid therapy.
- To differentiate site-specific tenderness from general hypersensitivity.
Main Methods:
- Dolorimetry was used to measure tenderness thresholds at shin, control, and "fibrositic" sites.
- 54 patients were studied: 26 on chronic steroid therapy and 28 controls.
- Observer variation was assessed by multiple observers.
Main Results:
- Patients on steroid therapy showed significantly increased tenderness at shin sites (mean threshold 3.0 kg vs. 5.6 kg in controls).
- Steroid therapy also led to a general increase in tenderness at control sites (2.0 kg increase).
- Increased tenderness, independent of steroid therapy, was observed in patients with lupus and in women.
Conclusions:
- Chronic steroid use specifically increases shin tenderness.
- Steroid therapy induces a generalized increase in pain sensitivity.
- Underlying mechanisms for steroid-induced tenderness may be both site-specific and systemic.