Preferred intraarticular corticosteroids and associated practice: A survey of members of the American College of Rheumatology

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Abstract
Objective. To determine which intraarticular steroids are used by rheumatologists and whether this use and associated practice vary with time and place of training. Method. American College of Rheumatology members were mailed questionnaires that focused on steroid use in the adult knee. Results. The steroids favored by the respondents were methylprednisolone acetate (MPA), preferred most by those trained in the eastern U.S.; triamcinolone hexacetonide (TH), preferred by those trained in the Midwest and Southwest; and triamcinolone acetonide (TA), preferred by those trained in the West. Only TH was chosen primarily because of efficacy. Regardless of concentration, respondents used 1 ml of steroid. Most (especially those recently trained) combined steroid with local anesthetic. Post-injection instructions varied: 29% did not restrict weight-bearing; 8% recommended limited weight-bearing for 1 week or more. Conclusion. MPA, TH, and TA were favored. Associated techniques varied, based in part on where and when training took place. Research is needed to provide a more rational basis for clinical practice.