title: Intraarticular morphine versus dexamethasone in chronic arthritis.
abstract: Intraarticular morphine inhibits pain after knee surgery without overt toxicity. This study examined intraarticular morphine in chronic arthritis. We undertook a randomized double-blind comparison between intraarticular morphine (3 mg), dexamethasone (4 mg) and saline (3 ml) in 44 patients with chronic inflammatory arthritis or osteoarthritis of the knee. Pain (the primary outcome measure) was assessed at rest and during activity for 6 days using a visual analog scale (VAS) and the McGill pain questionnaire. Before drug injections and on day 6 synovial leukocyte counts (the secondary outcome measure) were taken. During the first 6 h after injection both morphine and dexamethasone significantly reduced VAS and pain rating indices (PRI) in comparison to saline. Both substances also produced a significant reduction of PRI compared to saline during the subsequent 5 days. No patient displayed untoward side effects. Synovial leukocyte counts were lower after morphine than after saline. In conclusion, intraarticular morphine produces analgesia of similar magnitude to dexamethasone and it may have antiinflammatory actions in chronic arthritis.
authors.affiliation: Städtisches Krankenhaus München Bogenhausen, Akademisches Lehrkrankenhaus der Technischen Universität München, IV. Medizinische Abteilung, Rheumatologie, Klinische Immunologie, 81925 Munich, Germany Abteilung Statistik und Dokumentation, Max-Planck-Institut für Psychiatrie, 80804 Munich, Germany Klinik für Anaesthesiologie und operative Intensivmedizin, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stein
authors.forename: Alexander
authors.initials: A
authors.lastname: Yassouridis
authors.forename: Christopher
authors.initials: C
authors.lastname: Szopko
authors.forename: Klaus
authors.initials: K
authors.lastname: Helmke
authors.forename: Christoph
authors.initials: C
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000295:instrumentation; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010147:Pain Measurement; D013582:Synovial Fluid / Q000187:drug effects / Q000378:metabolism
chemical_list: D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D009020:Morphine; D003907:Dexamethasone