Caldwell J R
Florida Arthritis and Allergy Institute, Daytona Beach, USA.
Drugs. 1996 Oct;52(4):507-14. doi: 10.2165/00003495-199652040-00004.
Physicians have used intra- and periarticular corticosteroids for treating a variety of rheumatic diseases for nearly 50 years. Yet publications that have carefully examined the mechanisms of action, the pharmacokinetics and the comparative safety and efficacy of the available agents are sparse. This limits our ability to choose a drug scientifically. Similarly, we know little about the long term outcomes of joints infected with corticosteroids versus those not injected. Highly branched esters of methylprednisolone or triamcinolone are the preferred agents used by American rheumatologists. Pharmacokinetic studies reveal that triamcinolone hexacetonide, the least soluble of all the corticosteroid esters, is retained in the joint for 2 to 3 weeks. Intra-articular corticosteroids may implement their anti-inflammatory effect by down-regulating genetic expression of several pro-inflammatory proteins. A literature review suggests that judicious use of intra- and periarticular corticosteroids is very helpful in temporarily reducing pain and inflammation in musculoskeletal structures and may facilitate increased motion and function in selected cases. Their use in juvenile arthritis also appears to be safe and beneficial. Infection in or about the joint in the chief contraindication to use. Adverse effects are very few but the number of injections per joint should probably be limited to 4 or less per year.
近50年来，医生们一直使用关节内和关节周围注射皮质类固醇来治疗各种风湿性疾病。然而，仔细研究现有药物的作用机制、药代动力学以及比较安全性和疗效的出版物却很少。这限制了我们科学选择药物的能力。同样，对于注射了皮质类固醇的关节与未注射的关节的长期预后，我们了解甚少。甲基强的松龙或曲安奈德的高度支链酯是美国风湿病学家首选的药物。药代动力学研究表明，曲安奈德己酸酯是所有皮质类固醇酯中溶解度最低的，可在关节内保留2至3周。关节内注射皮质类固醇可能通过下调几种促炎蛋白的基因表达来发挥其抗炎作用。一项文献综述表明，明智地使用关节内和关节周围注射皮质类固醇对于暂时减轻肌肉骨骼结构的疼痛和炎症非常有帮助，并且在某些情况下可能有助于增加活动度和功能。它们在幼年型关节炎中的使用似乎也是安全和有益的。关节内或关节周围感染是使用的主要禁忌症。不良反应非常少，但每个关节每年的注射次数可能应限制在4次或更少。
