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Herbal and Supplement Use in Pain Management
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Dosing: Osteoarthritis: 16 mg as an intra-articular injection every two weeks.54Rheumatoid arthritis: 4 mg intra-articular injection once weekly for up to 6 weeks.55
Reactive arthritis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Intra-articular glucocorticoids: In patients who do not respond adequately to NSAIDs, injection of major affected joints with intra-articular glucocorticoids is recommended. Intra-articular injection with intra-articular triamcinolone acetonide (40 mg for a large joint, such as the knee, and lower doses for smaller joints) is generally effective in reducing joint inflammation and in providing symptomatic relief similar to that seen in other forms of spondyloarthritis.
The knee
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Andrew Price, Nick Bottomley, William Jackson
New forms of medication have been introduced in recent years and intra-articular injection of hyalourans is used as a treatment option. Unfortunately, there is little data to suggest the long-term efficacy of these treatments.
Reduction of systemic exposure and side effects by intra-articular injection of anti-inflammatory agents for osteoarthritis: what is the safer strategy?
Published in Journal of Drug Targeting, 2023
Zuoxu Xie, Lu Wang, Jie Chen, Zicong Zheng, Songpol Srinual, Annie Guo, Rongjin Sun, Ming Hu
To eliminate the concern about the long-term use of NSAIDs, scientists are developing new cyclooxygenase-2 (COX-2) inhibitors or IA drug delivery systems to reduce the systemic side effects for enabling the long-term use of NSAIDs in patients with comorbidities. However, although numerous IA formulations of NSAIDs have been developed and demonstrated to be effective in animal models, their systemic exposure and potential risk of local and systemic side effects have not been comprehensively studied. Hence, in this review, we introduce the rationale for the use of anti-inflammatory agents and the clinically available and potential products, and summarise the systemic exposure, local side effects, and systemic side effects of such anti-inflammatory agents with intra-articular injection. In addition, due to the increasing burden of OA and the demand for effective and safe medicines, we propose a new therapy that combines the locally active drug (soft drug/antedrug) and the sustained-release formulation to treat OA safely for long-term use.
Non-surgical osteoarthritis therapy, intra-articular drug delivery towards clinical applications
Published in Journal of Drug Targeting, 2021
Yujie Liang, Xiao Xu, Limei Xu, Indira Prasadam, Li Duan, Yin Xiao, Jiang Xia
Knees and hips are critical active joints in the human body, especially the knee joint, which is the largest of the weight-bearing joint; thus, knee arthritis incidence is very high. Currently, the most suitable route for local drug delivery of OA is intra-articular injection. A direct intra-articular injection is advantageous over systemic administration as drugs can be chosen that deliver to the diseased site and bypass the physiological barriers during transport in the body. The benefits of intra-articular injection of drugs for OA therapy include promoting bioavailability, reducing the adverse risk of systemic toxicity, and reducing the drugs’ total cost. A wide range of drugs has been developed to treat OA, including OA, including chondroitin sulphate (CS). and hyaluronic acid, which have been approved by the US Food and Drug Administration (FDA) and the European Medicines Quality Agency for clinical application. Other new treatments, such as intra-articular ozone injections, platelet-rich plasma, and mesenchymal stem cell transplantation, are in clinical trials [2,6–8]. Overall, currently, there is no clinical convincing and practical method to reverse joint cartilage destruction, indicating the search for new therapeutics is still in an urgent need.
How to effectively utilize imaging in disease-modifying treatments for osteoarthritis clinical trials: the radiologist’s perspective
Published in Expert Review of Molecular Diagnostics, 2021
Daichi Hayashi, Frank W. Roemer, Ali Guermazi
Ideally, a lateral projection X-ray after injection with a little deposition of air prior to the injection of the investigational compound or placebo itself would visually demonstrate correct needle placement (Figure 6(c)). Injecting under ultrasound guidance or aspirating some synovial fluid before injecting the drug does not provide definitive proof of intra-articular drug administration since the needle may move between such a two-step procedure [50]. Only a lateral X-ray showing air in the joint cavity can be the definitive proof of intra- or extra-articular injection [51]. The presence of intra-articular air typically causes clearly audible squishing sounds with range of motion post-injection, and can be used as an additional proof for successful injection [52]. Extra-articular injection of the drug results not only in unsuccessful delivery of the investigational agent and failure to assess its efficacy, but also potential adverse reaction, such as development of heterotopic ossification at follow-up (Figure 6(d,e)). It is therefore important to document the correct intra-articular injection. A procedural training manual will help in this regard and a training video may explain in addition how to do it best and with high success rates. Documentation of the correct needle placement should be based on an objective and undisputed lateral X-ray after deposition of intra-articular air.