Corticosteroids are medications that are commonly injected and many people refer to these injections as “cortisone” injections.
Corticosteroids are medications that are commonly injected and many people refer to these injections as “cortisone” injections. The first corticosteroid injection was performed in 1953 and the first clinical trial was performed in 1958 1,8. The medications are synthetically formulated to mimic the steroid hormone cortisone, which is produced by the adrenal gland and released in response to stress.
Intra-articular corticosteroids reduce synovial blood flow and alter local collagen synthesis 2. They have also been shown to decrease the local inflammatory modulator response by mechanisms such as interfering with inflammatory cell adhesion, interrupting cytokines like IL-1, and impairing leukotriene and prostaglandin synthesis 3. There are a few characteristics that are examined when looking at depot corticosteroids.
Solubility seems to be mentioned across the orthopedic specialty often and compounds with lower solubility are thought to remain at the injected site for longer periods of time and, in theory, have less systemic effect. Triamcinolone acetonide (Kenalog) is the least soluble of the commonly used injectable steroids, followed by triamcinolone hexacetonide (Aristospan) 4 . Crystal structure and duration of action are also typically factored in when choosing corticosteroids.
Microscopic comparison studies have shown methylprednisolone to be the largest particle, triamcinolone to be intermediate and betamethasone to be the smallest 5 , 6 . Comparison of corticosteroids (adopted from 4, 5, 6) The most commonly used corticosteroids include triamcinolone acetonide (Kenalog), betamethasone (Celestone) and methylprednisolone (Depo-medrol). The doses for triamcinolone and methylprednisolone are typically 20 mg,40 mg and 80 mg per mL.
The dosage for betamethasone is usually 6 mg/mL. Triamcinolone and methylprednisolone are branched esters and generally the preferred agents for joints. In a 1994 survey for college of rheumatology members, 35 % preferred methylprednisolone, 31 % preferred triamcinolone hexacetonide and 21 % preferred triamcinolone acetonide for knee osteoarthritis injections .
If you are experiencing symptoms that may be related to introduction and comparison of corticosteroids, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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