Despite the wearing effects on cartilage, corticosteroid injections are still done frequently due to the lack of insurance covered alternatives for knee osteoarthritis treatment.
Despite the wearing effects on cartilage, corticosteroid injections are still done frequently due to the lack of insurance covered alternatives for knee osteoarthritis treatment. A commonly used agent for intra-articular corticosteroid injections is triamcinolone acetonide. The benefits of a steroid injection are typically short lived with evidence showing that benefits may only last up to 4 weeks from administration.
This review looks at Zilretta, which is an extended-release poly microsophere-based formulation of triamcinolone acetonide. Zilretta Label Zilretta is an extended release triamcinolone that is formulated with poly lactic-co-glycolic acid microspheres with small triamcinolone crystals embedded throughout the matrix. The microspheres will break down and allow for slow drug release.
This slow breakdown has led to measurable triamcinolone levels in synovial fluid 12 weeks after an injection, where standard triamcinolone was not able to be detected 6 weeks from an injection. Another study showed that at four months from the injection, fifty percent of patients who received an extended relief triamcinolone injection still had symptom relief. The suspension is mixed in office with the 32mg of Triamcinolone coming in powder form and then mixed with 5mL of isotonic diluent made primarily of "an isotonic, sterile, aqueous solution of sodium chloride (NaCl; 0.9% w/w), sodium carboxymethylcellulose (CMC; 0.5% w/w), polysorbate-80 (0.1% w/w) and with sodium hydroxide (NaOH) and hydrochloric acid (HCl) as pH adjusters".
The slower release of triamcinolone was found to lower systemic exposure compared to immediate release formulations. The slower release has also led to lower glucose levels after injection in diabetics. One of the concerns with an extended release corticosteroid is increased adrenal suppression.
However, evidence shows there was no significant reduction in cortisol from the short acting or extended release triamcinolone. A study done by Spitzer in Rheumatology and Therapy also looked at repeat dosing of the extended release triamcinolone. They found that the second injection was well tolerated with no adverse effects and no deleterious effects on cartilage seen on imaging.
If you are experiencing symptoms that may be related to what is zilretta?, 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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