• George Habib, Rana Zahran, Ronza Najjar, Samih Badarny, Adel Jabbour, Suheil Artul, Geries Hakim, and Haneen Jabaly-Habib.
• Rheumatology clinic, Nazareth Hospital, Nazareth, and Department of Medicine, Carmel Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
• Swiss Med Wkly. 2015 Jan 1; 145: w14134.

Questions Under StudyIn this work we wanted to evaluate the effect of intra-articular injection (IAI) at the knee joint of 1 ml of Diprospan on the hypothalamic-pituitary-adrenal (HPA) axis.MethodsConsecutive patients attending the rheumatology or orthopaedic clinic with osteoarthritic knee pain not responding satisfactorily to medical and physical therapy were asked to participate in our study. After consent, patients had ultrasound-guided IAI of 1 ml of Diprospan, containing 2 mg of betamethasone sodium phosphate and 5 mg of betamethasone dipropionate. Demographic, clinical, laboratory and radiographic variables were documented. Just prior to the knee injection and 1, 2, 4 and 6 weeks later, patients had a 1-µg adrenocorticotropic hormone (ACTH) stimulation test. Secondary adrenal insufficiency (SAI) was defined as a poststimulation (30 minutes after ACTH injection) serum cortisol level of less than 18 µg/dl (~500 nmol/l) and lack of a rise of >6 µg/dl (~166 nmol/l) over the basal level in poststimulation serum cortisol.ResultsTwenty patients completed the study. There were 3 male and 17 female patients, with a mean age of 58.6±9.5 years. Six (30%) patients had evidence of SAI and in five of them it was seen at one time-point, mostly at week 2 after the IAI. In one patient, SAI was prolonged and observed from week 1 to week 4.ConclusionsIAI at the knee joint of 1 ml of Diprospan was associated with a transient high rate of SAI.

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