Cutaneous Atrophy Secondary to Intra-articular Corticosteroid Administration

Abstract

Article1 November 1966Cutaneous Atrophy Secondary to Intra-articular Corticosteroid AdministrationJAMES T. CASSIDY, M.D., F.A.C.P., GILES G. BOLE, M.D., F.A.C.P.JAMES T. CASSIDY, M.D., F.A.C.P., GILES G. BOLE, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-65-5-1008 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIntra-articular injection of adrenocorticosteroid has been shown to be a useful therapeutic procedure in the management of patients with rheumatoid arthritis. Wide variations in the therapeutic efficacy of hydrocortisone were observed, however, and were found to relate to the type of ester (1) and to the duration of its retention within the synovial space. More recently several synthetic derivatives with greater pharmacologic potency have been developed and compared with the anti-inflammatory activity of hydrocortisone tertiarybutylacetate (2). This presentation reports the occurrence of severe cutaneous atrophy of delayed onset at the site of intra-articular injection in eight patients with rheumatoid arthritis...References1. HOLLANDERBROWNJESSERUDELLSMUKLERBOWIE JLEMRALNMA: Local anti-rheumatic effectiveness of higher esters and analogues of hydrocortisone. Ann. Rheum. Dis. 13: 297, 1954. CrossrefMedlineGoogle Scholar2. HOLLANDER JL: Clinical use of dexamethazone; role in treatment of patients with arthritis. JAMA 172: 306, 1960. CrossrefMedlineGoogle Scholar3. BAKERWHITAKER BLWL: Interference with wound healing by the local action of adrenocortical steroids. Endocrinology 46: 544, 1950. CrossrefMedlineGoogle Scholar4. CASTORBAKER CWBL: The local action of adrenocortical steroids on epidermis and connective tissue of the skin. Endocrinology 47: 234, 1950. CrossrefMedlineGoogle Scholar5. JAMES AP: Intradermal triamcinolone acetonide in localized lesions. Antibiot. Med. 7: 495, 1960. Google Scholar6. HOLLANDER A: Intralesional injections of triamcinolone acetonide; a therapy for dermatoses. Antibiot. Med. 8: 78, 1961. Google Scholar7. REBELLO DJ: Intralesional triamcinolone acetonide in skin diseases other than psoriasis. Brit. J. Derm. 74: 358, 1962. MedlineGoogle Scholar8. FISHERMANFEINBERGFEINBERG EWARSM: Local subcutaneous atrophy. JAMA 179: 971, 1962. CrossrefMedlineGoogle Scholar9. BOLAND EW: Clinical comparison of the newer anti-inflammatory corticosteroids. Ann. Rheum. Dis. 21: 176, 1962. CrossrefMedlineGoogle Scholar10. PEARSE AG: Histochemistry, 2d ed. Little, Brown and Co., Boston, 1960. Google Scholar11. DUFFROBINSONMIKKELSENCHATELIN IFWDWMNH: Intra-articular hydrocortisone in rheumatoid arthritis. Med. Clin. N. Amer. 39: 413, 1955. CrossrefGoogle Scholar12. HOLLANDERJESSARBROWN JLRAEM: Intra-synovial corticosteroid therapy: a decade of use. Bull. Rheum. Dis. 11: 239, 1961. MedlineGoogle Scholar13. GOLDMANO'HARABASKETT LHEJ: The detection of crystals following local injection of cortisone and compound F into the skin of man. Science 116: 17, 1952. CrossrefGoogle Scholar14. GOLDMANTHOMPSONTRICE LRGER: Cortisone acetate in skin disease. Arch. Derm. (Chicago) 65: 177, 1952. Google Scholar15. ZACCORICHARDSONCRITTENDENHOLLANDERDOHAN MEMJOJLFC: Disposition of intra-articularly injected hydrocortisone acetate, hydrocortisone and cortisone acetate in arthritis. I. Concentrations in synovial fluid and cells. J. Clin. Endocr. 14: 711, 1954. CrossrefGoogle Scholar16. MCCARTYHOGAN DJJM: Inflammatory reaction after intrasynovial injection of microcrystalline adrenocorticosteroid esters. Arthritis Rheum. 7: 359, 1964. CrossrefMedlineGoogle Scholar17. HOLLANDERJESSARRESTIFOFORT JLRARAHJ: A new intra-articular steroid ester with longer effectiveness (abstract). Arthritis Rheum. 4: 422, 1961. Google Scholar18. HOLLANDERBROWNJESSARUDELLCOOPERBANDSMUKLER JLEMRALSNM: The effect of triamcinolone on psoriatic arthritis—a two year study. Arthritis Rheum. 2: 513, 1959. CrossrefMedlineGoogle Scholar19. IUELKRYGER JJ: Local cutaneous atrophy following corticosteroid injection. Acta Rheum. Scand. 11: 137, 1965. CrossrefMedlineGoogle Scholar20. JESSARHOLLANDER RAJL: Intrasynovial use of adrenal corticosteroids. Mod. Treatm. 1: 1288, 1964. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Ann Arbor, MichiganFrom the Rackham Arthritis Research Unit, Department of Internal Medicine, the University of Michigan Medical School, Ann Arbor, Mich.This work was supported in part by a grant from the Michigan Chapter of the Arthritis Foundation.Dr. Cassidy is a Postdoctoral Fellow and Dr. Bole, a Senior Investigator of the Arthritis Foundation.Portions of this study were presented before the Michigan regional meeting of the American College of Physicians, September 18, 1964, Gaylord, Mich.Requests for reprints should be addressed to James T. Cassidy, M.D., R4633 Kresge Medical Research Bldg., University of Michigan, Ann Arbor, Mich. 48104. 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