Abstract | BACKGROUND: Intra-articular corticosteroid injection (IACI) of betamethasone depot preparation is a popular procedure at the knee joint. Intra-articular corticosteroid injection in general could be associated with systemic effects including suppression of the hypothalamic-pituitary-adrenal axis. There are nearly no reports on the effect of IACI of betamethasone at the knee joint on the hypothalamic-pituitary-adrenal axis. METHOD: Consecutive patients attending the rheumatology or orthopedic clinic with osteoarthritic knee pain who were not responding satisfactorily to medical and physical therapy were allocated to group 1 after consent and given IACI of 6 mg of betamethasone acetate/ betamethasone sodium phosphate. After completion of this part, consecutive age- and sex-matched patients were allocated to group 2 and given intra-articular injection of 60 mg of sodium hyaluronate. Demographic, clinical, laboratory, and radiographic variables were documented. Just before the knee injection and 1, 2, 3, 4, and 8 weeks later, patients had 1-μg adrenocorticotropin hormone ( ACTH) stimulation test. Secondary adrenal insufficiency (SAI) was defined as levels of less than 18 µg/dL and lack of a rise of more than 6 µg/dL in serum cortisol level, 30 minutes after the ACTH stimulation test.Patients were blinded to the injected material, and all injections were ultrasound guided. RESULTS: Twenty patients were enrolled in each group and equally divided between the 2 sexes. The mean age of the patients was approximately 54 years in both groups. No significant difference in any variable was seen between the 2 groups. One patient only from group 1 (the betamethasone group) had SAI 3 weeks after the IACI compared to none in the control group (P > 0.9999). His serum cortisol level 30 minutes after the ACTH stimulation was 17 µg/dL, with a rise of 3 µg/dL from baseline. CONCLUSION:
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Authors | George Habib, Suheil Artul, Mark Chernin, Geries Hakim, Adel Jabbour |
Journal | Journal of investigative medicine : the official publication of the American Federation for Clinical Research
(J Investig Med)
Vol. 61
Issue 7
Pg. 1104-7
(Oct 2013)
ISSN: 1708-8267 [Electronic] England |
PMID | 24013525
(Publication Type: Journal Article)
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Chemical References |
- betamethasone sodium phosphate
- Betamethasone
- betamethasone acetate
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Topics |
- Adult
- Aged
- Betamethasone
(administration & dosage, analogs & derivatives)
- Case-Control Studies
- Female
- Humans
- Hypothalamo-Hypophyseal System
(drug effects, metabolism)
- Injections, Intra-Articular
- Knee Joint
(drug effects, metabolism)
- Male
- Middle Aged
- Osteoarthritis, Knee
(blood, drug therapy)
- Pituitary-Adrenal System
(drug effects, metabolism)
- Treatment Outcome
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