Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel.
J Clin Rheumatol. 2011 Sep;17(6):302-5. doi: 10.1097/RHU.0b013e31822acd7c.
The objective of the study was to evaluate the effect of intra-articular (IA) triamcinolone hexacetonide (TAH) and triamcinolone acetonide (TA) on blood glucose levels in patients with controlled diabetes with symptomatic osteoarthritis of the knee (OAK).
Patients with controlled diabetes with symptomatic OAK who failed nonsteroidal anti-inflammatory medication and physical therapy and use modern versions of self-monitoring blood glucose devices were offered an IA injection of either 20 mg of TAH or 40 mg of TA. If agreed, patients were asked to document blood glucose levels before and 2 hr after meals for 1 week before and daily for 5 days then every other day for 1 week following the injection. The type of IA preparation was given on an alternating pattern. A sex- and aged-matched group of patients with controlled diabetes with symptomatic OAK of the knee was offered an IA hyaluronic acid (HA) injection. Significantly increased blood glucose level following the IA injection was defined as higher by at least 2 SDs than the mean comparable level before the injection.
Thirty patients completed the study: 12 patients in the TAH, 12 patients in the TA group, and 6 in the HA group. All the patients who received triamcinolone preparations had significantly increased blood glucose levels with median initial levels of 227.5 and 201 mg% seen at a median of 8.5 and 13 hr following the IA injection and median peak levels of 288 and 239.5 mg% seen after a median of 24.5 and 32.5 hr following the IA injection of TA and TAH, respectively. Levels returned to normal after ∼2.5 to ∼4 days. There was no significant increase in the HA group except in 1 measurement only with marginal level in 2 patients.
Intra-articular injection of either TAH or TA is associated with significantly increased blood glucose levels in patients with controlled diabetes with OAK. This increase is quite solely due to the injected steroids.
本研究旨在评估关节内（IA）曲安奈德己酮（TAH）和曲安奈德（TA）对伴有症状性膝骨关节炎（OAK）的糖尿病控制患者血糖水平的影响。
对接受非甾体抗炎药物和物理治疗失败且使用现代版自我监测血糖设备的糖尿病控制伴症状性 OAK 患者，给予 20mg TAH 或 40mg TA 的 IA 注射。如果同意，患者被要求在注射前 1 周记录饭前和饭后 2 小时的血糖水平，每天记录 5 天，然后在注射后每周记录 2 天。IA 制剂的类型以交替模式给予。对一组年龄和性别匹配的糖尿病控制伴症状性膝骨关节炎患者给予 IA 透明质酸（HA）注射。IA 注射后血糖水平显著升高定义为至少比注射前平均水平高 2 个标准差。
30 名患者完成了研究：TAH 组 12 名患者，TA 组 12 名患者，HA 组 6 名患者。接受曲安奈德制剂治疗的所有患者血糖水平均显著升高，IA 注射后中位数为 8.5 小时和 13 小时，初始中位数分别为 227.5 和 201mg%，IA 注射后中位数为 24.5 和 32.5 小时，中位数分别为 288 和 239.5mg%。峰值水平在注射后约 2.5 至 4 天恢复正常。HA 组除仅在 1 次测量中略有增加外，无显著增加。
IA 注射 TAH 或 TA 与糖尿病控制伴 OAK 患者的血糖水平显著升高相关。这种增加完全是由于注射的类固醇。
