[The intraarticular and local administration of glucocorticosteroid preparations].
The author reports the use of short-acting and combined short + long-acting betamethasone injections for intraarticular and local treatments. In this paper the author describes his experiences with intraarticular and local treatments of 214 patients with 965 short-acting, and 416 patients with 2932 combined short + long-acting betamethasone preparations from 1978 to 2003.


OBJECTIVE
To describe the optimal application of intraarticular and local steroid therapy based on the author's experience and according to the literature data.


METHODS
Patients were selected on the bases of rheumatological, laboratory and imaging investigations. The preparations were administered according to ARA guidelines. The results were evaluated based on patients' health status and symptoms, in addition to patients' and doctors' opinion.


RESULTS
A combination of intraarticular short-acting + long-acting betamethasone injections resulted in patients being symptom-free (48.8%) or with significant improvement (37.5%), while local application led to a significant improvement (50%) or improvement (29%). Locally applied short-acting betamethasone resulted in symptom-free or significantly improved cases (40.6%), or ordinary improvement (40.3%). The short-acting + long-acting preparation was associated with mild side effects (62 cases), while the short-acting one had fewer mild side effects (10). The results are in agreement with the literature data, though in present author's case with a much fewer number of side effects.


CONCLUSIONS
Intraarticular application of a combined short-acting + long acting agent is suggested exclusively in cases of visible and laboratory signs of inflammation that are limited to a few joints. In a treatment episode, not more than 3 injections may be permitted except in special cases. Initially, extraarticular management of cases is recommended using mainly short-acting preparations, except in protracted cases or when the application of short-acting steroids prove ineffective. Short-acting agents have little or short-term manifestations of corticosteroid toxicity. Taking such factors into consideration, treatment may be regarded as beneficial and safe. The aim of this publication is partly to influence practices in Hungarian surgeries.
Siró
Béla
B
Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, I. Belgyógyászati Klinika, Debrecen. drsirobela@index.hu
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001182:Arthroscopy / Q000009:adverse effects; D001623:Betamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D001623:Betamethasone