title: The effect of intra-articular injection of Diprospan at the knee joint on the hypothalamic-pituitary-adrenal axis.
abstract: OBJECTIVE
  In this work we wanted to evaluate the effect of intra-articular injection (IAI) at the knee joint of 1 ml of Diprospan on the hypothalamic-pituitary-adrenal (HPA) axis.
  
  
  METHODS
  Consecutive patients attending the rheumatology or orthopaedic clinic with osteoarthritic knee pain not responding satisfactorily to medical and physical therapy were asked to participate in our study. After consent, patients had ultrasound-guided IAI of 1 ml of Diprospan, containing 2 mg of betamethasone sodium phosphate and 5 mg of betamethasone dipropionate. Demographic, clinical, laboratory and radiographic variables were documented. Just prior to the knee injection and 1, 2, 4 and 6 weeks later, patients had a 1-µg adrenocorticotropic hormone (ACTH) stimulation test. Secondary adrenal insufficiency (SAI) was defined as a poststimulation (30 minutes after ACTH injection) serum cortisol level of less than 18 µg/dl (~500 nmol/l) and lack of a rise of >6 µg/dl (~166 nmol/l) over the basal level in poststimulation serum cortisol.
  
  
  RESULTS
  Twenty patients completed the study. There were 3 male and 17 female patients, with a mean age of 58.6±9.5 years. Six (30%) patients had evidence of SAI and in five of them it was seen at one time-point, mostly at week 2 after the IAI. In one patient, SAI was prolonged and observed from week 1 to week 4.
  
  
  CONCLUSIONS
  IAI at the knee joint of 1 ml of Diprospan was associated with a transient high rate of SAI.
authors.affiliation: Rheumatology clinic, Nazareth Hospital, Nazareth, and Department of Medicine, Carmel Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: George
authors.initials: G
authors.lastname: Habib
authors.affiliation: Department of Medicine, Rambam Medical Centre, Haifa, Israel.
authors.forename: Rana
authors.initials: R
authors.lastname: Zahran
authors.affiliation: Department of Medicine, Carmel Medical Centre, Haifa, Israel.
authors.forename: Ronza
authors.initials: R
authors.lastname: Najjar
authors.affiliation: Department of Neurology, Carmel Medical Centre, Haifa, Israel.
authors.forename: Samih
authors.initials: S
authors.lastname: Badarny
authors.affiliation: Central Lab, Nazareth Hospital, Nazareth, Israel.
authors.forename: Adel
authors.initials: A
authors.lastname: Jabbour
authors.affiliation: Department of Radiology, Nazareth Hospital, Nazareth, Faculty of Medicine in Galilee, Bar-Ilan University, Israel.
authors.forename: Suheil
authors.initials: S
authors.lastname: Artul
authors.affiliation: Department of Orthopaedics, Nazareth Hospital, Nazareth, Faculty of Medicine in Galilee, Bar-Ilan University, Israel.
authors.forename: Geries
authors.initials: G
authors.lastname: Hakim
authors.affiliation: Department of Ophthalmology, Baruch Padeh Hospital, Poriya, Faculty of Medicine in Galilee, Bar-Ilan University, Israel.
authors.forename: Haneen
authors.initials: H
authors.lastname: Jabaly-Habib
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D007270:Injections, Intra-Articular; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010913:Pituitary-Adrenal System / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; C032812:betamethasone dipropionate, betamethasone sodium phosphate drug combination; D001623:Betamethasone; D006854:Hydrocortisone