Endocrine Abstracts

Background: 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 joint injection, the preparation used, the dosage and frequency of injection. The adverse effects of IAGC can often be overlooked by both the patient and physician 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.

Aim: We provide an overview on the often under-recognised effects of IAGC on HPA-axis function.

Results and conclusions: IAGC can result in a sharp decline in cortisol to low or undetectable levels within the first days after administration. HPA-axis suppression can typically last for up to 4 weeks after a single injection, although recovery of HPA-axis to baseline can take longer depending on the dose and frequency of injections. Considering the widespread use of IA steroid injections and their clinical effectiveness, physicians who administer them need to be aware of the potential risks of HPA-axis suppression and/or iatrogenic Cushing syndrome. Guidelines for the frequency of dosing in addition to defined time intervals between each injection should be clear. High risk populations have the potential to be screened for adrenal suppression and could include those who receive high doses and multiple injections particularly within the previous 6 months. The potential use of the measurement of salivary cortisol in identifying patients who have subtle changes in HPA-axis function remains to be seen.