Glucocorticoid resorption and influence on the hypothalamic-pituitary-adrenal axis after intra-articular treatment of the knee in resting and mobile patients
Glucocorticoid resorption and influence on the hypothalamic-pituitary-adrenal axis after intra-articular treatment of the knee in resting and mobile patients
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DOI：
10.1136/ard.2005.041525
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发表时间：
2006-07-01
影响因子：
27.4
通讯作者：
Rönnblom, LR
中科院分区：
文献类型：
--
作者：
Weitoft, T;Rönnblom, LR
背景资料：研究表明，膝关节滑膜炎的关节内糖皮质激素注射治疗在休息的患者中比在移动的患者中具有更好的结局。这一观察结果的一个原因可能是休息延缓了类固醇的再吸收，导致局部治疗效果增强。目的：研究药物吸收和激素生产的影响下丘脑-垂体-肾上腺轴关节内糖皮质激素给药后，与和没有postinjection rest.Methods：20例类风湿性关节炎和膝关节滑膜炎患者随机分为24小时卧床休息或正常活动后，关节内糖皮质激素治疗20 mg曲安奈德（THA）。结果：观察到短期和可逆的血清皮质醇和促肾上腺皮质激素（ACTH）水平下降（p < 0.001），在休息和移动的患者之间没有任何显着差异。THA水平增加相似，在两组中，与中位数血清峰值后8 hours.Conclusion：固定不出现关节内给药后，延缓糖皮质激素再吸收。因此，需要进一步的研究来阐明关节内糖皮质激素治疗膝关节滑膜炎后休息的有益作用背后的机制。
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.