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Journal of Orthopaedic Surgery and... Feb 2022The pathogenesis and treatment of lateral elbow epicondylitis (LEE) are still controversial. The purpose of the current study was to evaluate the production of...
BACKGROUND
The pathogenesis and treatment of lateral elbow epicondylitis (LEE) are still controversial. The purpose of the current study was to evaluate the production of inflammatory cytokines by LEE-derived cells and to compare the anti-inflammatory effect of triamcinolone acetonide with platelet-rich plasma (PRP) on cytokines production in primary culture of these cells.
METHODS
Third passage cells from primary cultures of LEE were assessed for the production of the cytokines IL-1β, IL-6, IL-8, IL-10 and TNF-α by immune-enzymatic assay (ELISA), after the treatment with 1, 10 and 100 μM triamcinolone compared to no treated controls at the time points 6, 12, 18, 24, 48, 72 and 96 h, and to PRP at 48, 72 and 96 h.
RESULTS
The cytokines IL-6 and IL-8 were produced in high concentrations by LEE cells. One, 10 and 100 μM triamcinolone induced significant decrease in the production of IL-6 and IL-8 at 48, 72 and 96 h, adding the time point 12 h for IL-8. Compared to controls, PRP caused a significant increase in the production of IL-6 and IL-8 and there was a significant increase in IL-10 production with the use of 100 μM triamcinolone at 48 h. The production of IL1-β and TNF-α was very low and did not change when the cultures were treated with triamcinolone or PRP.
CONCLUSION
LEE-derived cells produce IL-6 and IL-8, confirming the inflammatory nature of this condition. While triamcinolone inhibited the production of IL-6 and IL-8 by LEE cells, PRP induced an increase in these cytokines compared with controls.
Topics: Cytokines; Humans; Interleukin-10; Interleukin-6; Interleukin-8; Platelet-Rich Plasma; Tennis Elbow; Triamcinolone; Tumor Necrosis Factor-alpha
PubMed: 35168647
DOI: 10.1186/s13018-022-02990-0 -
Journal of Ayub Medical College,... 2022Osteoarthritis is a heterogeneous disease of joints that affects mainly older population. Definitive cure of osteoarthritis is still undiscovered. This study was...
BACKGROUND
Osteoarthritis is a heterogeneous disease of joints that affects mainly older population. Definitive cure of osteoarthritis is still undiscovered. This study was designed to evaluate and compare the chondroprotective effects of hyaluronic acid and triamcinolone in murine model of osteoarthritis.
METHODS
This Laboratory based experimental study was carried out in Pharmacology Department, Army Medical College Rawalpindi, from April-June 2019. Osteoarthritis was induced by medial menisectomy and anterior cruciate ligament resectioning of knee joints of twenty-four rats which were then divided into three groups with eight rats in each. Group I, II and III were named control, hyaluronic acid and triamcinolone groups respectively, which were given intra-articular injections of these drugs once weekly for four consecutive weeks and then gait pattern was scored. Animals were sacrificed thereafter and samples were collected for histopathological analysis.
RESULTS
Comparison of gait score of control, hyaluronic acid and triamcinolone groups exhibited a p value of <0.01 while intergroup comparison between group I and II, group I and III and group II and III depicted p-value of <0.001, 0.016 and 0.003 respectively. Likewise, collective histopathological analysis of the three groups showed p-value of <0.01 while intergroup comparison of group I and II, group I and III and group II and III showed p-value of <0.001 for all.
CONCLUSIONS
Comparison of control group with treatment groups proved chondroprotective effects of hyaluronic acid and triamcinolone. Additionally, hyaluronic acid proved to provide better chondroprotection as compared to triamcinolone.
Topics: Animals; Disease Models, Animal; Humans; Hyaluronic Acid; Injections, Intra-Articular; Mice; Osteoarthritis, Knee; Rats; Triamcinolone
PubMed: 35466632
DOI: 10.55519/JAMC-01-9566 -
The Journal of International Medical... Oct 2023This study was performed to assess the impact of autologous conditioned serum (ACS) when added to preceding intra-articular glucocorticoid therapy on pain, function, and... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study was performed to assess the impact of autologous conditioned serum (ACS) when added to preceding intra-articular glucocorticoid therapy on pain, function, and quality of life outcomes over 24 weeks.
METHODS
In this single-center, randomized controlled trial involving 40 patients with advanced knee osteoarthritis (Kellgren-Lawrence grades III and IV), ACS or saline placebo was injected after 40 mg triamcinolone acetonide (TA) intra-articular injection. Numerical rating scale (NRS) pain scores and Knee Injury and Osteoarthritis Outcome Score (KOOS) assessments were conducted at baseline and at weeks 3, 6, 12, and 24. The primary endpoint was the change in KOOS Pain at 24 weeks. Patient safety events were also monitored.
RESULTS
At week 24, TA + ACS significantly improved KOOS Pain, Symptoms, Activities of Daily Living, Quality of Life, and KOOS Sport scores. TA + ACS also outperformed TA + placebo in NRS pain scores (average and maximum intensity) at week 24 and NRS pain score (at rest) at weeks 12 and 24. The TA injection followed by ACS or placebo was well-tolerated.
CONCLUSION
ACS adds long-term pain relief and functional improvement to the short-term pain relief provided by glucocorticoids.
Topics: Humans; Osteoarthritis, Knee; Double-Blind Method; Quality of Life; Activities of Daily Living; Treatment Outcome; Triamcinolone; Pain; Glucocorticoids; Injections, Intra-Articular; Triamcinolone Acetonide
PubMed: 37818751
DOI: 10.1177/03000605231203851 -
Pediatric Rheumatology Online Journal Mar 2021Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is... (Comparative Study)
Comparative Study
BACKGROUND
Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection.
METHODS
Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children's Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA.
RESULTS
Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted.
CONCLUSION
Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.
Topics: Adolescent; Anti-Inflammatory Agents; Arthritis, Juvenile; Child; Child, Preschool; Female; Glucocorticoids; Humans; Infant; Injections, Intra-Articular; Male; Retrospective Studies; Treatment Outcome; Triamcinolone Acetonide
PubMed: 33743721
DOI: 10.1186/s12969-021-00520-6 -
Pain Physician Jul 2017Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions aimed at reducing this inflammation could prevent PHN. One option is the epidural administration of corticosteroid and local anesthetic. However, several authors have reported a risk of arachnoiditis with epidural corticosteroids. Subcutaneous injection in an outpatient setting is a safer option. However, there is limited evidence of the effectiveness of this alternative for preventing PHN.
OBJECTIVES
The aim of this study was to assess the effectiveness of subcutaneous injection of triamcinolone and lidocaine for the prevention of PHN in elderly HZ patients.
STUDY DESIGN
Randomized, single-center, clinical trial.
SETTING
Department of pain management of a teaching hospital in Beijing, China.
METHODS
Patients with acute HZ with rash < 7 days (n = 100) were randomly assigned to receive either standard therapy (oral antivirals and analgesics) alone or standard therapy plus subcutaneous injection of triamcinolone and lidocaine. The severity of pain was assessed using a numeric rating scale (NRS) at enrollment and at one, 3, and 6 months after rash onset. Quality of life (QoL) was evaluated by the SF-36 before treatment and at 3 and 6 months after rash onset. The primary endpoint was the presence of zoster-associated pain (ZAP) at 3 months after rash onset.
RESULTS
At enrollment, all patients reported ZAP with average NRS scores of 6.64 ± 1.44 and 7.16 ± 1.22 in the standard group and subcutaneous group, respectively. At 3 and 6 months after rash onset, the pain had decreased in both groups, but the decrease was significantly greater in the subcutaneous injection group. At 3 months, 2 (4%) patients in the subcutaneous injection group vs. 10 (20%) patients in the standard group had ZAP with NRS > 3 (P = 0.014). Both groups showed significant improvement in QoL at 3 and 6 months. No patient had major adverse events related to the subcutaneous injection.
LIMITATIONS
The main limitation of the study was the absence of a placebo subcutaneous injection in the standard group.
CONCLUSION
Subcutaneous injection of triamcinolone and lidocaine in the acute phase of HZ can reduce ZAP more effectively than oral antivirals and analgesics alone, and may be a feasible method to prevent PHN.
KEY WORDS
Subcutaneous injection, lidocaine, triamcinolone, postherpetic neuralgia, prevention.
Topics: Aged; Anesthetics, Local; China; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Injections, Subcutaneous; Lidocaine; Male; Middle Aged; Neuralgia, Postherpetic; Outcome Assessment, Health Care; Triamcinolone
PubMed: 28727702
DOI: No ID Found -
The American Journal of Managed Care Nov 2022Standard ocular drug delivery methods generally are safe and effective for treating diseases of the eye. However, many routes of administration carry the risk of adverse... (Review)
Review
Standard ocular drug delivery methods generally are safe and effective for treating diseases of the eye. However, many routes of administration carry the risk of adverse effects due to drug exposure to anterior ocular tissues. Additionally, these delivery methods may not result in high and consistent levels of a therapeutic agent delivered to target tissues for diseases affecting the posterior segment of the eye. Injection into the suprachoroidal space (SCS) represents an alternative method of ocular drug delivery to the posterior segment. SCS injection facilitates targeted distribution to affected chorioretinal tissues for potential efficacy benefits, compartmentalization away from unaffected anterior segment tissues for potential safety benefits, and a high degree of bioavailability. Furthermore, the SCS may serve as a drug depot for long-acting drug delivery of small-molecule suspensions. Until recently, drug delivery to the SCS could be achieved only in the operating room setting with anesthetic immobilization of the eye and surgical dissection through the sclera. A novel microneedle device, the SCS Microinjector® (Clearside Biomedical, Inc) was developed to permit physicians to administer therapies safely and reliably into the SCS in the office setting. Successful use of SCS injection has been demonstrated with triamcinolone acetonide injectable suspension (Xipere®, Bausch + Lomb), a novel formulation optimized for use with the SCS Microinjector®. FDA approval of this combination drug and device for the treatment of macular edema associated with uveitis (UME) was based on outcomes from the phase 3 PEACHTREE study (NCT02595398); other important studies included its long-term observational extension (MAGNOLIA; NCT02952001) and an open-label safety study (AZALEA; NCT03097315). The SCS Microinjector® together with triamcinolone acetonide injectable suspension for use in the SCS presents an opportunity for safe and effective drug delivery for the treatment of UME and, potentially, for broader use with alternate medications to treat other ocular diseases that impact chorioretinal tissues (eg, age-related macular degeneration, diabetic retinopathy, choroidal melanoma).
Topics: Humans; Microinjections; Choroid; Triamcinolone Acetonide; Needles; Choroidal Effusions; Observational Studies as Topic
PubMed: 36395492
DOI: 10.37765/ajmc.2022.89270 -
Dermatology Online Journal Oct 2011Melkersson-Rosenthal Syndrome (MRS) is a rare syndrome that is characterized by a triad of facial paralysis, chronic edema of the lip, and a fissured tongue. Most... (Review)
Review
Melkersson-Rosenthal Syndrome (MRS) is a rare syndrome that is characterized by a triad of facial paralysis, chronic edema of the lip, and a fissured tongue. Most commonly, one element of the triad precedes the development of the other symptoms. We present a case of cheilitis granulomatosa (CG) as a manifestation of incomplete MRS. As the etiology remains unknown, treatment of CG is challenging. Intralesional glucocorticoids remain the first-line treatment, but recurrences are common. We discuss alternative treatment strategies that include combination therapy with other anti-inflammatory agents and biologics, such as infliximab.
Topics: Adult; Anti-Inflammatory Agents; Antibodies, Monoclonal; Biopsy; Crohn Disease; Female; Humans; Infliximab; Injections, Intralesional; Lidocaine; Lip; Melkersson-Rosenthal Syndrome; Syndrome; Triamcinolone; Tumor Necrosis Factor-alpha
PubMed: 22031641
DOI: No ID Found -
Journal of the Royal Society of Medicine Dec 1988
Topics: Humans; Injections; Tenosynovitis; Triamcinolone; Wrist
PubMed: 3221373
DOI: No ID Found -
The Western Journal of Medicine Sep 1980
Topics: Humans; Injections; Keloid; Triamcinolone; Triamcinolone Acetonide
PubMed: 7415179
DOI: No ID Found -
Acta Ophthalmologica Nov 2021Diabetic macular oedema (DMO), a complication of diabetes, causes vision loss and blindness. Corticosteroids are usually used as a second-line treatment. The aim of this...
PURPOSE
Diabetic macular oedema (DMO), a complication of diabetes, causes vision loss and blindness. Corticosteroids are usually used as a second-line treatment. The aim of this study was to analyse the cost-effectiveness of dexamethasone implants compared to cheaper and more frequently applied triamcinolone injections.
METHODS
Markov-modelling, which incorporated both eyes, was used for economic evaluation. The model consisted of five health states based on visual acuity, illustrating the progression of DMO. A cycle length of five months was chosen for dexamethasone and four months for triamcinolone. Time horizons of two and five years were applied. Transition probabilities and health state utilities were sourced from previous studies. The perspective used in this analysis was the hospital perspective. The health care costs were acquired from Kuopio University Hospital in Finland.
RESULTS
In this cost-effectiveness analysis, the incremental cost-effectiveness ratio ICER with 3% discount rate was €56 591/QALY for a two-year follow-up and -€1 110 942/QALY for a five-year follow-up. In order to consider dexamethasone as cost-effective over a 2-year time horizon, the WTP needs to be around €55 000/QALY. Over the five-year follow-up, triamcinolone is clearly a dominant treatment. Sensitivity analyses support the cost-effectiveness of dexamethasone over a 2-year time horizon.
CONCLUSIONS
Since the sensitivity analyses support the results, dexamethasone would be a cost-effective treatment during the first two years with WTP threshold around €55 000/QALY, and triamcinolone would be a convenient treatment after that. This recommendation is in line with the guidelines of EURETINA.
Topics: Aged; Cost-Benefit Analysis; Dexamethasone; Diabetic Retinopathy; Disease Progression; Finland; Follow-Up Studies; Glucocorticoids; Health Care Costs; Humans; Macular Edema; Markov Chains; Quality-Adjusted Life Years; Time Factors; Treatment Outcome; Triamcinolone; Visual Acuity
PubMed: 33421332
DOI: 10.1111/aos.14745