Intra-articular triamcinolone acetonide for joint inflammation

Despite the somewhat negative tone of this article it is no surprise that triamcinolone (TA) was found to ameliorate the inflammation created by the studies methodology. The somewhat short acting nature of TA has been considered one of its benefits and to make it safer than repositol steroids (DepoMedrol / methylpred) when it comes to the possible but often exaggerated deleterious effects of steroids on joints. Long time equine joint specialist (and my own orthopedic surgeon) believe that they get a much better effect with the use of methylpred on chronic osteoarthritis. And so do I. TA may be best used for acute joint trauma during the phase that inflammation may lead to longer term problems.
DrO

Treatment effects of intra-articular triamcinolone acetonide in an equine model of recurrent joint inflammation

Equine Vet J. 2020 Dec 6. doi: 10.1111/evj.13396. Online ahead of print.
Authors
C M Kearney 1 , N M Korthagen 2 , S G M Plomp 2 , M C Labberté 1 , J C de Grauw 2 , P R van Weeren 2 , P A J Brama 1
Affiliations

1 UCD School of Veterinary Medicine, University College Dublin, Ireland.
2 Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.

Abstract

Background: Intra-articular triamcinolone acetonide is a widely used treatment for joint inflammation despite limited scientific evidence of its efficacy.

Objectives: To investigate if intra-articular triamcinolone acetonide has sustained anti-inflammatory effects using an equine model of repeated joint inflammation.

Study design: Randomised controlled experimental study.

Method: For three consecutive cycles 2 weeks apart, inflammation was induced in both middle carpal joints of 8 horses by injecting 0.25 ng lipopolysaccharide (LPS). After the first LPS injection only, treatment with 12 mg triamcinolone acetonide followed in one randomly assigned joint, while the contralateral joint was treated with sterile saline (control). Clinical parameters (composite welfare scores, joint effusion, joint circumference) were recorded and synovial fluid samples were analysed for various biomarkers (total protein, WBCC; PGE2 ; CCL2; TNFα; MMP; GAGs; C2C; CPII) at fixed time points (post-injection hours 0, 8, 24, 72 and 168). The effects of time and treatment on clinical and synovial fluid parameters and the presence of time-treatment interactions were tested using a linear mixed model for repeated measures with horse as a random effect, and time and treatment as fixed effects.

Results: The triamcinolone treated joints showed significantly higher peak synovial GAG concentrations (Difference in means 283.1875 µg/ml, 95% CI 179.8, 386.6, p <0.000), and PGE2 levels (Difference in means 77.8025 pg/ml, 95% CI 21.2, 134.4, p <0.007) after the first inflammation induction. Significantly lower TP levels were seen with TA treatment after the second induction (Difference in means -7.5 g/L, 95% CI -14.8, -0.20, p <0.04) . Significantly lower WBCC levels were noted with TA treatment after the first (Difference in means -23.7125 x 109 cells/L, 95% CI -46.7, -0.7, p <0.04) and second (Difference in means -35.95 x 109 cells/L, 95% CI -59.0, -12.9, p <0.002) inflammation inductions. Significantly lower general MMP activity was also seen with TA treatment after the second inflammation inductions (Difference in means -51.65 RFU/s, 95%CI -92.4, -10.9, p <0.01).

Main limitations: This experimental study cannot fully reflect natural joint disease.

Conclusions: In this model, intra-articular TA seems to have some anti-inflammatory activity (demonstrated by reductions in TP, WBCC and general MMP activity) up to 2 weeks post treatment but not at 4 weeks. This anti-inflammatory effect appeared to outlast a shorter-lived, potentially detrimental effect illustrated by increased synovial GAG and PGE2 levels after the first induction.