• The Korean Journal of Physiology and Pharmacology
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• v.20 no.1
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• pp.129-136
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• 2016

This study was performed to investigate whether an intra-articular injection of transient receptor potential vanilloid 1 (TRPV1) receptor agonist, resiniferatoxin (RTX) would alleviate behavioral signs of arthritic pain in a rat model of osteoarthritis (OA). We also sought to determine the effect of RTX treatment on calcitonin gene-related peptide (CGRP) expression in the spinal cord. Knee joint inflammation was induced by intra-articular injection of monosodium iodoacetate (MIA, $8mg/50{\mu}l$) and weight bearing percentage on right and left hindpaws during walking, paw withdrawal threshold to mechanical stimulation, and paw withdrawal latency to heat were measured to evaluate pain behavior. Intra-articular administration of RTX (0.03, 0.003 and 0.0003%) at 2 weeks after the induction of knee joint inflammation significantly improved reduction of weight bearing on the ipsilateral hindlimb and increased paw withdrawal sensitivity to mechanical and heat stimuli. The reduction of pain behavior persisted for 3~10 days according to each behavioral test. The MIA-induced increase in CGRP immunoreactivity in the spinal cord was decreased by RTX treatment in a dose-dependent manner. The present study demonstrated that a single intra-articular administration of RTX reduced pain behaviors for a relatively long time in an experimental model of OA and could normalize OA-associated changes in peptide expression in the spinal cord.

• Journal of Oral Medicine and Pain
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• v.48 no.1
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• pp.25-30
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• 2023

We present the case of a 60-year-old male with post-macrotrauma disc displacement and retrodiscitis, in which temporomandibular joint (TMJ) injection and manual therapy were used to alleviate his symptoms. He visited our clinic with complaints of pain and swelling in his right facial area and malocclusion of his right side teeth after being hit on the right side of his face five days earlier. During clinical and radiological examinations, the inflammatory state of the joint and disc displacement on the right side, which led to malocclusion, were noted. At the initial visit, we performed TMJ intracapsular injection and prescribed medications to control pain and inflammation. Simultaneously, manual manipulation was performed to relocate the disc. The same treatments were employed two days later. However, 10 days after the first visit, his symptoms did not mitigate substantially. We also performed magnetic resonance imaging (MRI), prescribed nortriptyline, and created a stabilization splint. MRI images depicted inflammatory disc displacement and joint effusion in the right TMJ. Based on the accurate diagnosis, we kept administering a stabilization splint, intra-articular injection, and medication. His signs and symptoms were alleviated 20 days after the initial visit and did not reoccur for the next 40 days.

• Korean Journal of Clinical Pharmacy
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• v.17 no.1
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• pp.38-45
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• 2007

Background: The multitude of the therapeutic usefulness of intra-articular injection of hyaluronate on oateoarthritis of the knee is still in question. The objective of this systemic review was to elucidate both the therapeutic efficacy and the safety of intra-articular administration of hyaluronic acid for degenerative osteoarthritis of the knee joints. Methods: I searched MEDLINE and Korea Medical Database (KMbase) from January 1990 to April 2007 using a combination search terms for knee osteoarthritis and hyaluronic acid and a filter for randomized controlled trials. I extracted data on pain at rest, and during or just after movement, on joint function, and on adverse events. Results: Ten trials that reported usable quantitative information on any of the predefined end points were identified and included in the systemic review. Intra-articular injection of hyaluronic acid can decrease symptoms of osteoarthritis of the knee. The study revealed significant improvements in pain and functional outcomes with few adverse effects. However, there was significant between-study heterogeneity in the estimates of the efficacy of hyaluronic acid. Sub-group analysis showed that lower methodological quality such as a single-blind or single-center design resulted in higher estimates hyaluronic acid efficacy, and that patients older than sixty years of age and those with the most advanced radiographic stage of osteoarthritis were less likely to benefit from intra-articular injection of hyaluronic acid. Conclusion: According to the currently available evidence, intra-articular hyaluronic acid has been proven clinically effective for the patients bearing the knee osteoarthritis with NSAID-induced GI troubles or inapplicable to any surgery, and may be associated with lower risk of adverse events.

• Biomolecules & Therapeutics
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• v.22 no.3
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• pp.260-266
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• 2014

This study evaluated the pharmacokinetic profile and therapeutic efficacy of piroxicam (PX), a long acting non-steroidal anti-inflammatory drug for the treatment of arthritis, following intra-articular (IA) injection in comparison to the pharmacokinetic profile and therapeutic efficacy of PX after intramuscular (IM) injection. In the pharmacokinetic study in rats, systemic exposure and pharmacokinetic parameters of PX after a single IA dose were compared with systemic exposure and pharmacokinetic parameters of PX after administration of the same dose IM (0.6 mg/kg). The anti-inflammatory and analgesic effects of IA PX were evaluated simultaneously in a monoiodoacetate-induced osteoarthritis rat model. The plasma PX concentration rapidly rose following IA injection, and it was comparable to the plasma PX concentration following IM injection, suggesting the rapid efflux of the drug molecule from the joint cavity. However, in the efficacy study, the IA PX administration significantly reduced the knee swelling by reducing the level of prostaglandin $E_2$ in the joint, compared to that following administration of IA vehicle and after administration of the IM PX dose. In addition, we found that the anti-inflammatory and anti-nociceptive efficacies of IA PX were synergistically increased upon co-treatment with hyaluronic acid (HA), a potent agent for the treatment of osteoarthritis, at the weight ratio of 1:1 or 1:2, and these effects were more pronounced than those following administration of HA or PX alone. In conclusion, this study demonstrated the efficacy of the IA use of PX alone and/or in combination with HA in osteoarthritis.

• Journal of the Korean Society of Radiology
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• v.82 no.1
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• pp.162-172
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• 2021

Purpose We retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet. Materials and Methods We selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up. Results The success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients. Conclusion For patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.

• Clinics in Shoulder and Elbow
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• v.17 no.2
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• pp.50-56
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• 2014

Background: To assess the clinical outcomes of short-term oral corticosteroid therapy for impingement syndrome of the shoulder and determine whether it can be substituted as an alternative to the intra-articular injection. Methods: The clinical outcomes of the 173 patients, the oral steroid group (n=88) and the injection group (n=85), were measured at 3 weeks, 2, 4, and 6 months postoperatively. The clinical outcomes were assessed by measuring the the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) and range of motion (ROM) at every follow-up. Any complications and recurrence rate were noted. A relationship between the treatment outcomes and factors such as demographic factors, clinical symptoms and radiographic findings were determined. Results: No difference was observed in VAS and UCLA scores between the two groups, but forward flexion and internal rotation of ROM were significantly improved in the injection group at the 2nd and 4th postoperative month (p < 0.05). At 6th postoperative month, recurrence rate of symptoms was 26% in the oral steroid group and 22% in the injection group. No major adverse effects were observed. When the clinical outcomes of the oral steroid group were compared to either demographic, clinical symptoms, or radiographic findings, UCLA score was found to be significantly low (p < 0.05) in patients with joint stiffness and UCLA score, whereas VAS score was significantly improved in patients with night pain (p < 0.05). Conclusions: Short-term low-dose oral corticosteroid therapy of impingement syndrome showed comparable clinical outcomes to intra-articular injection without any remarkable adverse effects. Low-dose oral steroids can be regarded as a partial alternative to intra-articular injection for the initial therapy of impingement syndrome of the shoulder.

• Clinical Pain
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• v.18 no.2
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• pp.121-125
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• 2019

Arthritis of hip joints deteriorates the quality of life in ankylosing spondylitis (AS) patients. Secondary to the articular inflammatory process, the shortened hip-girdle muscles contribute to the decreased joint mobility which may lead to the functional impairment. As the limitation of range of motion (ROM) usually progress slowly, clinicians regard it as a chronic condition and prescribe long-term therapy. However, by short-term intensive multimodal treatment, a 20-year-old man diagnosed as AS with severely limited hip joint ROM who relied on crutches doubled the joint angle and could walk independently only within 2 weeks. The combination included intra-articular steroid injection, electrical twitch obtaining intramuscular stimulation, extracorporeal shock wave therapy, heat, manual therapy, and stretching exercises. The management focused on the relaxation of hip-girdle muscles as well as the direct control of intra-articular inflammation. Hereby, we emphasize the effectiveness of intensive multimodal treatment in improving the function even within a short period.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.3
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• pp.262-267
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• 2006

The term temporomandibular disorders is used to describe a group of conditions that involve the temporomandibular joint, masticatory muscles, and associated structures. Many modalities have been proposed for treating temporomandibular disorders, including medication, physical therapy, occlusal stabilization splints with or without manual repositioning, surgery, and arthrocentesis. Temporomandibular disorders are treated in a step-wise manner. Initially, conservative treatment is used. Depending on the response, more aggressive interventions may be necessary. This usually takes the form of arthrocentesis. Arthrocentesis is used in the treatment of not only acute, closed, and locked TMJs but also various other temporomandibular disorders. Recently, the intra-articular injection of sodium hyaluronate after arthrocentesis was shown to have long-term palliative effects on TMJ symptoms. Synovial fluid consists of plasma and glycosaminoglycan, including hyaluronic acid derived from synovial cells. Sodium hyaluronate, the sodium salt of hyaluronic acid, is a high-molecular-weight polysaccharide and a major component of synovial fluid. This highly viscous substance has analgesic properties, lubricant effects, and anti-inflammatory actions; it causes cartilage formation and plays a role in the nutrition of avascular parts of the disc and condylar cartilage. We conclude that the intra-articular injection of sodium hyaluronate is effective for treating temporomandibular disorders.

• Journal of Korean Medicine Rehabilitation
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• v.25 no.4
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• pp.21-28
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• 2015

Objectives This study was aimed to offer basic data in long term drug efficacy test using monosodium iodoacetate-induced osteoarthrits model. Methods Sixty male rats were divided into normal and osteoarthritic group. Rats of normal group were injected with 0.1 ml physiological saline, and rats of osteoarthritic group were inected with 0.1 ml monosodium iodoacetate (3 mg/ml) into each left and right knee joint cavities. Gross examination, proteoglycan contents and histopathological examination on the knee joint were performed at 10, 20, 40, and 60 days after injection. Results Grossly, degenerative changes at 10 days, desquamation at 40 days, and ulceration of articular cartilages at 60 days were observed. Proteoglycan contents in articular cartilages were decreased rapidly to 40 days, after than decreased gradually. Osteoarthritic scores were increased rapidly to 20 days, after than increased gradually to 60 days. Conclusions From above results, osteoarthritis model induced by a single intra-articular injection of monosodium iodoacetete is useful model for long term drug efficacy test.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.64-70
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• 2023

Background: This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). Methods: In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. Results: A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P<0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P<0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. Conclusions: Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI. Level of evidence: III.