Q:局部注射固醇類藥物Triamcinolone Acetonide安全嗎?


Feb. 5, 2003根據一項隨機雙盲試驗研究結果顯示,注射類固醇對於治療膝蓋骨關節炎,經過兩年的實驗時間證實,沒有明顯的副作用。研究報告發表在二月份的Arthritis & Rheumatism。

作者:Laurie Barclay, MD
審閱:Gary D. Vogin, MD

加拿大蒙特婁大學Notre-Dame醫院Jean-Pierre Raynauld博士表示,此研究結果支持在膝蓋骨關節炎病人關節內注射類固醇治療是長期安全的,而重複注射類固醇作為骨關節炎的長期治療在臨床上也是有效的。
68位膝蓋骨嚴重罹患關節炎患者當中,有34位每三個月接受注射40 mg triamcinolone acetonide,另外34位是安慰劑對照組。所有病人同時接受簡單止痛劑和非類固醇抗炎藥物治療。
經過兩年的治療後,關節腔狹窄的放射性檢查結果在兩組未見差異。接受長期類固醇治療病人症狀有很大的改善,特別是在治療一年後,根據Western Ontario and McMaster大學骨關節炎指數 (WOMAC) 疼痛評分、晚上疼痛以及活動範圍值都有很大改善 (P = .05),膝蓋疼痛和僵直類固醇治療組也有顯著改善 (P < .05)。
Dr. Raynauld表示,雖然此研究不能證實注射類固醇可以預防軟骨退化,令人振奮的是已強調重複關節內注射類固醇是安全的,它不但可以緩解疼痛也與疾病的加速進展無關。
Steroid Injections Safe, Effective Long-term in Knee Osteoarthritis
By Laurie Barclay, MD
Medscape Medical News

Feb. 5, 2003 —l Injecting steroids for the management of pain related to osteoarthritis of the knee had no apparent deleterious effects over two years, according to the results of a randomized, double-blind trial reported in the February issue of Arthritis & Rheumatism.
"Our findings support the long-term safety of intraarticular steroid injections for patients with symptomatic knee osteoarthritis," lead author Jean-Pierre Raynauld, MD, from Notre-Dame Hospital of the University of Montreal in Quebec, Canada, says in a news release. "Moreover, long-term treatment of knee osteoarthritis with repeated steroid injections appeared to be clinically effective for the relief of symptoms of the disease."
Of 68 subjects with severe osteoarthritis of the knee, 34 received injections of 40 mg triamcinolone acetonide into the affected knee every three months, while the 34 controls received the same schedule of placebo injections with saline. All patients were allowed treatment with simple analgesics and nonsteroidal anti-inflammatory drugs.
The primary outcome variable of radiologic progression of joint space narrowing over two years was not different between groups. Patients who received long-term steroid injections showed a trend toward greater symptom improvement, especially at one year, on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, night pain, and range of motion values (P = .05). Over the two-year study period, knee pain and stiffness were significantly improved in the steroid group but not in the control group (P < .05).
"Although our study did not demonstrate that steroid injections may prevent cartilage degradation, it is reassuring to note that after two years of injections, no significant difference between the two experimental groups was noted," Dr. Raynauld says. "This finding addresses the safety issue of repeated intraarticular injections of steroids for pain relief and suggests that these injections were not associated with accelerated disease progression."

Arthritis Rheum. 2003;48:370-377
Reviewed by Gary D. Vogin, MD

2007-09-11 09:36:22