Pharmacology of intra-articular triamcinolone.
BACKGROUND
The inflammatory joint diseases of juvenile inflammatory arthritis (JIA), rheumatoid arthritis (RA) and osteoarthritis (OA): and also mild to moderate joint injury, all require a multidisciplinary approach to management. Intra-articular injections of corticosteroids have been shown to be a very beneficial adjunctive treatment in the management of the above disorders. It is, therefore, important that clinicians have a good understanding of the clinical actions of intra-articular injections.


OBJECTIVE
This article explores the pharmacokinetics, pharmacodynamics, and clinical pharmacology of triamcinolone acetonide (TA) and triamcinolone hexacetonide (TH) in JIA, RA, and OA.


METHODS
Literature search of TA and TH articles was conducted using key word searches in the PubMed and Google Scholar databases and through references within found articles.


RESULTS
TA and TH intra-articular injections have been shown to provide good clinical benefit for up to 6 months and even longer. TH has been shown to decrease in the expression of citrullinated proteins, the monoclonal antibody F95, and peptidylarginine deiminase 4 in RA synovium. TA and TH intra-articular injections have a low side effect profile which is similar to other corticosteroid. They have minimal to no mineralocorticoid adverse effects and facial flushing 2-3 days post injections is the most common side effect recorded, and in almost all cases is no worse than nuisance.


CONCLUSIONS
TA and TH are useful adjunct therapies in the management of JIA, RA, OA, and mild to moderate joint injury.
McMaster University Faculty of Life Sciences, Hamilton, ON, L8S 4K1, Canada.
Justin
J
Scherer
K D
KD
Rainsford
Colin A
CA
Kean
Walter F
WF
Kean
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D010003:Osteoarthritis / Q000188:drug therapy / Q000503:physiopathology; D013997:Time Factors; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide