Intraarticular corticosteroids in treatment of osteoarthritis

The history of the use of intraarticular corticosteroids in the treatment of osteoarthritis and the various available corticosteroid preparations, their possible mechanism of action, side effects, and results of treatment are presented. The longest-lasting effects in the alleviation of joint symptomatology are produced by the tertiary-butyl acetate esters of the various corticosteroid preparations. The effect produced by triamcinolone appears to be of the longest duration. The anti-inflammatory action of corticosteroids seems to be responsible for the alleviation of joint symptomatology in osteoarthritis. Significant adverse effects, such as steroid arthropathy and tendon rupture, may result from excessive intraarticular use. Infection is an uncommon complication when adequate skin preparation is performed. The major disadvantage of intraarticular corticosteroids is their short duration of action, averaging two to three weeks. However, a small percentage of patients with osteoarthritis may sustain prolonged relief from one or two injections. Acute self-limited disorders, such as trigger finger and inflamed bursae, seem to lend themselves best to this form of therapy.