Duarte-Monteiro Ana Margarida, Dourado Eduardo, Fonseca João E, Saraiva Fernando
Centro Hospitalar Universitário Lisboa Norte (CHULN).
ARP Rheumatol. 2023 Jan-Mar;2(1):64-73.
Intra-articular glucocorticoid injection (IAGCI) is frequently used to treat joint pain and inflammation. While its efficacy has been extensively studied, there are not as many detailed descriptions regarding safety. This review aimed to describe the immediate-, short- and long-term complications of IAGCI and their predictors. Most studies mainly report mild and self-limited adverse events with an incidence similar to placebo. However, the reported incidences vary significantly and are mostly inferred from retrospective data. Septic arthritis is the most feared adverse event due to its association with high mortality. Other short-term local complications include injection site pain, post-injection flare, skin hypopigmentation and atrophy, and tendon rupture. Systemic side effects are common, including vasovagal reactions, flushing, increased appetite and mood changes, hyperglycemia in diabetic patients, and bleeding in high-risk patients. Few predictors of complications have been systematically evaluated. However, male gender, advanced age, and pre-existing joint disease have been suggested in retrospective studies to correlate with infection risk. Overall, in most studies, only severe adverse event rates are reported, with no systematic prospective evaluations of safety and no report of predictors of complications. Therefore, since IAGCI is a routinely used treatment, more detailed knowledge of adverse events and complications is warranted.
关节内糖皮质激素注射（IAGCI）常用于治疗关节疼痛和炎症。虽然其疗效已得到广泛研究，但关于安全性的详细描述却不多。本综述旨在描述IAGCI的即刻、短期和长期并发症及其预测因素。大多数研究主要报告轻度且自限性的不良事件，其发生率与安慰剂相似。然而，报告的发生率差异很大，且大多是从回顾性数据推断而来。化脓性关节炎因其与高死亡率相关，是最令人担忧的不良事件。其他短期局部并发症包括注射部位疼痛、注射后炎症反应、皮肤色素减退和萎缩以及肌腱断裂。全身副作用很常见，包括血管迷走神经反应、潮红、食欲增加和情绪变化、糖尿病患者的高血糖以及高危患者的出血。很少有并发症的预测因素得到系统评估。然而，回顾性研究表明，男性、高龄和既往存在的关节疾病与感染风险相关。总体而言，在大多数研究中，仅报告了严重不良事件发生率，没有对安全性进行系统的前瞻性评估，也没有关于并发症预测因素的报告。因此，由于IAGCI是一种常用治疗方法，有必要更详细地了解不良事件和并发症。
