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Pharmacology of intra-articular triamcinolone

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Abstract

Introduction

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.

Conclusion

TA and TH are useful adjunct therapies in the management of JIA, RA, OA, and mild to moderate joint injury.

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Conflict of interest

None of the authors has any financial or other type of agreement or contract with any of the manufacturers of triamcinolone acetonide or triamcinolone hexacetonide. This article was produced for academic interest only.

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Authors and Affiliations

  1. McMaster University Faculty of Life Sciences, Hamilton, ON, L8S 4K1, Canada

    Justin Scherer

  2. Biomedical Research Centre, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB, UK

    K. D. Rainsford

  3. Universita Vita-Salute, San Raffaelle, Milan, Italy

    Colin A. Kean

  4. Department of Medicine (Rheumatology), McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada

    Walter F. Kean

  5. McMaster University, #401, 1 Young Street, Hamilton, ON, L8N 1T8, Canada

    Walter F. Kean

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  1. Justin Scherer
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  2. K. D. Rainsford
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  3. Colin A. Kean
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Correspondence to Walter F. Kean.

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Scherer, J., Rainsford, K.D., Kean, C.A. et al. Pharmacology of intra-articular triamcinolone. Inflammopharmacol 22, 201–217 (2014). https://doi.org/10.1007/s10787-014-0205-0

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