The value of hydrocortisone given intra-articularly in the treatment of arthritis has been well established by a number of investigators. In addition to hydrocortisone acetate, various analogues and derivatives of hydrocortisone have been studied. As a result of these studies, certain specific dose recommendations have been made.
Hollander and associates1 have studied extensively this means of therapy and in one study based on 1,700 injections1c suggested that the way is open to finding analogues or esters of hydrocortisone having still more lasting palliative effect. Hollander has recommended injections of from 25 to 50 mg. of hydrocortisone acetate, with 50 mg. as the maximum dose.1d This upper-dose recommendation was based on the apparent inability of the synovial lining of the joint to absorb efficiently a greater quantity of the drug because of the "overflow effect" leading to systemic manifestations. In my experience, however, doses of this magnitude
Norcross BM. INTRA-ARTICULAR ADMINISTRATION OF HYDROCORTISONE IN HIGH CONCENTRATION: USE IN TREATMENT OF ARTHRITIC KNEES. JAMA. 1958;167(7):839–841. doi:10.1001/jama.1958.72990240001008
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