Johnston Philip C, Lansang M Cecilia, Chatterjee Soumya, Kennedy Laurence
Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, OH, 44195, USA,
Endocrine. 2015 Mar;48(2):410-6. doi: 10.1007/s12020-014-0409-5. Epub 2014 Sep 3.
The use of intra-articular (IA) glucocorticoids for reducing pain and inflammation in patients with osteoarthritis, rheumatoid arthritis, and other inflammatory arthropathies is widespread among primary care physicians, specialists, and non-specialists in the United States. Injectable glucocorticoids have anti-inflammatory and analgesic properties which can be effective in improving clinical parameters such as pain, range of motion, and quality of life. After injection into the IA space, glucocorticoids may be systemically absorbed; the degree of absorption can depend on the size of the joint injected, the injectable glucocorticoid preparation used, the dosage, and the frequency of the injection. The adverse effects of intra-articular glucocorticoid injections (IAGC) can often be overlooked by both the patient and physicians who administer them, in particular the potential deleterious effect on the hypothalamic-pituitary-adrenal (HPA)-axis which can result in adrenal suppression and/or iatrogenic Cushing syndrome. In this paper we provide an overview on the often under-recognized effects of IAGC on HPA-axis function.
在美国，关节内（IA）注射糖皮质激素用于减轻骨关节炎、类风湿关节炎和其他炎性关节病患者的疼痛和炎症，这在初级保健医生、专科医生和非专科医生中广泛应用。注射用糖皮质激素具有抗炎和止痛特性，可有效改善疼痛、关节活动范围和生活质量等临床指标。注入关节腔后，糖皮质激素可能会被全身吸收；吸收程度取决于注射关节的大小、所用注射用糖皮质激素制剂、剂量和注射频率。关节内糖皮质激素注射（IAGC）的不良反应往往会被患者和实施注射的医生忽视，尤其是对下丘脑 - 垂体 - 肾上腺（HPA）轴的潜在有害影响，这可能导致肾上腺抑制和/或医源性库欣综合征。在本文中，我们概述了IAGC对HPA轴功能常常未被充分认识的影响。
