Habib George, Zahran Rana, Najjar Ronza, Badarny Samih, Jabbour Adel, Artul Suheil, Hakim Geries, Jabaly-Habib Haneen
Rheumatology clinic, Nazareth Hospital, Nazareth, and Department of Medicine, Carmel Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Department of Medicine, Rambam Medical Centre, Haifa, Israel.
Swiss Med Wkly. 2015 May 21;145:w14134. doi: 10.4414/smw.2015.14134. eCollection 2015.
In this work we wanted to evaluate the effect of intra-articular injection (IAI) at the knee joint of 1 ml of Diprospan on the hypothalamic-pituitary-adrenal (HPA) axis.
Consecutive patients attending the rheumatology or orthopaedic clinic with osteoarthritic knee pain not responding satisfactorily to medical and physical therapy were asked to participate in our study. After consent, patients had ultrasound-guided IAI of 1 ml of Diprospan, containing 2 mg of betamethasone sodium phosphate and 5 mg of betamethasone dipropionate. Demographic, clinical, laboratory and radiographic variables were documented. Just prior to the knee injection and 1, 2, 4 and 6 weeks later, patients had a 1-µg adrenocorticotropic hormone (ACTH) stimulation test. Secondary adrenal insufficiency (SAI) was defined as a poststimulation (30 minutes after ACTH injection) serum cortisol level of less than 18 µg/dl (500 nmol/l) and lack of a rise of >6 µg/dl (166 nmol/l) over the basal level in poststimulation serum cortisol.
Twenty patients completed the study. There were 3 male and 17 female patients, with a mean age of 58.6±9.5 years. Six (30%) patients had evidence of SAI and in five of them it was seen at one time-point, mostly at week 2 after the IAI. In one patient, SAI was prolonged and observed from week 1 to week 4.
IAI at the knee joint of 1 ml of Diprospan was associated with a transient high rate of SAI.
在本研究中，我们想要评估在膝关节内注射1毫升得宝松对下丘脑-垂体-肾上腺（HPA）轴的影响。
连续纳入在风湿科或骨科门诊就诊、患有骨关节炎膝关节疼痛且对药物和物理治疗反应不佳的患者参与我们的研究。获得患者同意后，对其进行超声引导下膝关节内注射1毫升得宝松，其中含有2毫克倍他米松磷酸钠和5毫克倍他米松二丙酸酯。记录人口统计学、临床、实验室和影像学变量。在膝关节注射前以及注射后1、2、4和6周，患者接受1微克促肾上腺皮质激素（ACTH）刺激试验。继发性肾上腺功能不全（SAI）定义为刺激后（ACTH注射后30分钟）血清皮质醇水平低于18微克/分升（约500纳摩尔/升），且刺激后血清皮质醇水平较基础水平升高幅度>6微克/分升（约166纳摩尔/升）。
20名患者完成了研究。其中男性3名，女性17名，平均年龄58.6±9.5岁。6名（30%）患者有SAI证据，其中5名患者在某一个时间点出现SAI，大多在膝关节内注射后第2周。1名患者的SAI持续存在，在第1周至第4周均观察到。
膝关节内注射1毫升得宝松与SAI的短暂高发生率相关。
