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Glucocorticoid resorption and influence on the hypothalamic-pituitary-adrenal axis after intra-articular treatment of the knee in resting and mobile patients
  1. T Weitoft1,
  2. L Rönnblom2
  1. 1Department of Research and Development, County Council of Gävleborg/Uppsala University, Section of Rheumatology, Gävle Hospital, Sweden
  2. 2Department of Medical Science, Section of Rheumatology, Uppsala University Hospital, Sweden
  1. Correspondence to:
    Dr T Weitoft
    Section of Rheumatology, Department of Internal Medicine, Gävle Hospital, 801 87 Gävle, Sweden; tomas.weitoft{at}lg.se

Abstract

Background: Studies have shown that intra-articular glucocorticoid injection treatment for knee synovitis has a better outcome in resting patients than in mobile patients. One reason for this observation might be that rest retards steroid resorption, causing an enhanced local treatment effect.

Objectives: To study drug resorption and the impact on hormone production in the hypothalamic-pituitary-adrenal axis after intra-articular glucocorticoid administration, with and without postinjection rest.

Methods: Twenty patients with rheumatoid arthritis and knee synovitis were randomised to either 24 hour bed rest or normal activity after intra-articular glucocorticoid treatment with 20 mg triamcinolone hexacetonide (THA). Serum levels of THA, cortisol, and adrenocorticotropic hormone (ACTH) were followed during 2 weeks.

Results: Short term and reversible decreases in serum cortisol and ACTH levels (p<0.001) were seen, without any significant differences between resting and mobile patients. The THA levels increased similarly in both groups, with the median serum peak seen after 8 hours.

Conclusion: Immobilisation does not appear to retard glucocorticoid resorption after intra-articular administration. Further studies are therefore needed to clarify the mechanism behind the beneficial effects of rest after intra-articular glucocorticoid treatment for knee synovitis.

  • ACTH, adrenocorticotropic hormone
  • DAS28, 28 joint count Disease Activity Score
  • HAQ, Health Assessment Questionnaire
  • HPA, hypothalamic-pituitary-adrenal
  • IA, intra-articular
  • THA, triamcinolone hexacetonide
  • arthritis
  • intra-articular glucocorticoid
  • unloading
  • glucocorticoid resorption
  • hypothalamic-pituitary-adrenal-axis

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Footnotes

  • Competing interests: None.

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