Osteoarthritis is a major cause of disability among older adults. Treatment of the symptoms involves multiple modalities, including exercise, physical measures such as braces or canes, analgesics, and sometimes surgery. Many studies have demonstrated the utility of intra-articular corticosteroids in the knee, but data on their use in other joints are lacking. Intra-articular corticosteroids alleviate pain in the short term but have little effect on long-term function. Overall, they are quite safe, with relatively few contraindications or complications. Intra-articular corticosteroids are a temporizing measure rather than definitive therapy and are most useful in the treatment of acute exacerbations of osteoarthritis pain, to alleviate symptoms as other therapies are instituted, and to tide patients over as they await surgery.
Key words: osteoarthritis, corticosteroids, intra-articular, injections, therapy.
Giant cell arteritis (GCA) is the most common form of vasculitis in the older adult population. There are variable clinical presentations of this entity and no perfect diagnostic test, often making the diagnosis challenging. Prompt initiation of corticosteroids may prevent visual loss in affected individuals. Temporal artery biopsy remains the gold standard for diagnosing GCA. Patients require an individualized steroid tapering schedule to minimize side effects. Physicians caring for these patients should be aware of the potential for long-term vascular complications of GCA.
Key words: giant cell arteritis, temporal arteritis, vasculitis, ESR, corticosteroids.
Polymyalgia rheumatica (PMR) has a female predominance and typically occurs in people over 50 years of age. PMR usually presents as pain and stiffness in the neck, shoulder, and pelvic areas. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are used to determine disease activity. PMR is thought to be a systemic component of giant cell arteritis with aborted vasculitis. Other studies have looked at infectious agents as a causative factor. PMR is treated using a corticosteroid regime that, in turn, causes many unwanted side effects. Various methods to decrease these unwanted effects have been studied, including the addition of methotrexate as a steroid-sparing agent and intramuscular injection of methylprednisolone rather than oral prednisolone.
Key words: erythrocyte sedimentation rate, C-reactive protein, vasculitis, corticosteroids, side effects.
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