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Intra-articular glucocorticoid injections and their effect on hypothalamic-pituitary-adrenal (HPA)-axis function.
[cushing syndrome]
The
use
of
intra-articular
(
IA
)
glucocorticoids
for
reducing
pain
and
inflammation
in
patients
with
osteoarthritis
,
rheumatoid
arthritis
,
and
other
inflammatory
arthropathies
is
widespread
among
primary
care
physicians
,
specialists
,
and
non-specialists
in
the
United
States
.
Injectable
glucocorticoids
have
anti-
inflammatory
and
analgesic
properties
which
can
be
effective
in
improving
clinical
parameters
such
as
pain
,
range
of
motion
,
and
quality
of
life
.
After
injection
into
the
IA
space
,
glucocorticoids
may
be
systemically
absorbed
;
the
degree
of
absorption
can
depend
on
the
size
of
the
joint
injected
,
the
injectable
glucocorticoid
preparation
used
,
the
dosage
,
and
the
frequency
of
the
injection
.
The
adverse
effects
of
intra-articular
glucocorticoid
injections
(
IAGC
)
can
often
be
overlooked
by
both
the
patient
and
physicians
who
administer
them
,
in
particular
the
potential
deleterious
effect
on
the
hypothalamic
-
pituitary
-
adrenal
(
HPA
)
-
axis
which
can
result
in
adrenal
suppression
and
/
or
iatrogenic
Cushing
syndrome
.
In
this
paper
we
provide
an
overview
on
the
often
under-recognized
effects
of
IAGC
on
HPA-axis
function
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated