Letter to the Editor
Safety of the administration of local corticosteroids in diabetic patients: Historical cohort study comparing the use of triamcinolone and betamethasone
Seguridad de la administración de corticoides locales en pacientes diabéticos: estudio de cohortes históricas comparando el uso de triamcinolona y betametasona
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During this period our unit had a specific patient register which included a post infiltration follow-up programme which had been partially documented in a previous communication.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The diabetic patient records were analysed where an ultrasound-guided infiltration had been performed and a follow-up file had been completed at least one month after. Only records of intra-articular and intrabursal infiltrations were included.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The available corticosteroids during this period were triamcinolone-acetonide (C<span class="elsevierStyleInf">24</span>H<span class="elsevierStyleInf">31</span>FO<span class="elsevierStyleInf">6</span>, PM<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>434.5<span class="elsevierStyleHsp" style=""></span>g/mol)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and betamethasone disodium phosphate (C<span class="elsevierStyleInf">22</span>H<span class="elsevierStyleInf">28</span>FNa<span class="elsevierStyleInf">2</span>O<span class="elsevierStyleInf">8</span>P, PM<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>516.4<span class="elsevierStyleHsp" style=""></span>g/mol)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mg of betamethasone-acetonide (C<span class="elsevierStyleInf">29</span>H<span class="elsevierStyleInf">33</span>FO<span class="elsevierStyleInf">6</span>, PM<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>496.6<span class="elsevierStyleHsp" style=""></span>g/mol).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The patients were grouped together depending on the corticosteroid administered. The dependent variables were the number of hyperglycaemias that required emergency medical assessment, changes to their antidiabetic treatment guidelines or the need for hospital admission.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two hundred and fifty eight infiltrations performed on 210 patients were analysed. Of these 210 patients 116 (55.2%) were male. The mean age was 50.3 years, SD: 7.8 (range: 19–92 years). The proportion of patients with a diagnosis of diabetes of over 10 years onset was 61.4%. During the follow-up period 161 infiltrations with betamethasone-acetonide (group A) were performed and 97 with betamethasone disodium phosphate and betamethasone-acetonide (group B). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the anatomical location of the infiltration distribution.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Simple hyperglycaemia was recorded in 19 patients from group A (11.8%) and 11 patients from group B (11.3%) Simple hyperglycaemias which required emergency medical attention were recorded (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05). It was not necessary to change oral or insulin antidiabetic guidelines in any case. None of the patients were hospitalized.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Out of the total patients who received an infiltration at shoulder level with any corticosteroid (49), 11 presented with simple hyperglycaemia which required medical assessment. Of these 11 patients, 3 (37.5%) had been immobilised with the use of a sling and 8 had not. Of the 38 patients who did not present with simple hyperglycaemia and who were infiltrated at shoulder level, 34 (89.4%) were immobilised and 4 were not (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0001; exact Fisher's test). The age of the patients on infiltration administration, the date of diagnosis of diabetes, the type of antidiabetic treatment and the concomitant use of anaesthetics were not associated with the development of hyperglycaemias in the patients who were followed up (data not shown).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Recommendations for the use of low corticosteroid doses in infiltration to diabetic patients are the result of observational studies which did not exclusively include this type of patient.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Systemic diffusion depends on several factors, including the molecular weight of the substance infiltrated, the integrity of the synovial membrane, its vascularity and the pressure within the synovial fluid cavity.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,8</span></a> We have only included ultrasound guided infiltrations aimed at reducing the possibility of extra synovial deposit, increasing procedural precision.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">We understand that both triamcinolone and betamethasone are comparatively safe corticosteroids since the proportion of hyperglycaemias that have required medical assessment was below 12% and also no hospital admissions were required.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally, it appears that immobilisation of the shoulder reduces the risk of hyperglycaemias, probably because the increase of pressure within the subacromial bursa is avoided, and this procedure could therefore be included within the recommendations for diabetic patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guillen Astete CA, Diaz Garcia N, Laso Jimeno B, Luque Alarcon M. Seguridad de la administración de corticoides locales en pacientes diabéticos: estudio de cohortes históricas comparando el uso de triamcinolona y betametasona. Reumatol Clin. 2020;16:370–371.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A; <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>161 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B; <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>97 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Knee</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>External parapatellar recess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (30.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Popliteal bursa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patellar bursa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Elbow</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anterior recess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Olecranon fossa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Olecranon bursa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ankle</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tibia-talus joint \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Shoulder</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subacromial deltoid bursa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (23.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glenohumeral joint \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Carpus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2360337.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of infiltrations according to anatomical location. The magnitudes are expressed in absolute and percentile values with regards to their category.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uso de la ecografía en la valoración y abordaje terapéutico del hombro doloroso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Guillén Astete" 1 => "J. Usón" 2 => "A. Rodriguez García" 3 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 11 | 24 |
| 2024 October | 68 | 21 | 89 |
| 2024 September | 85 | 26 | 111 |
| 2024 August | 69 | 36 | 105 |
| 2024 July | 62 | 26 | 88 |
| 2024 June | 81 | 32 | 113 |
| 2024 May | 50 | 23 | 73 |
| 2024 April | 49 | 22 | 71 |
| 2024 March | 43 | 27 | 70 |
| 2024 February | 41 | 31 | 72 |
| 2024 January | 35 | 28 | 63 |
| 2023 December | 37 | 34 | 71 |
| 2023 November | 32 | 39 | 71 |
| 2023 October | 33 | 30 | 63 |
| 2023 September | 70 | 43 | 113 |
| 2023 August | 37 | 7 | 44 |
| 2023 July | 25 | 25 | 50 |
| 2023 June | 26 | 27 | 53 |
| 2023 May | 30 | 24 | 54 |
| 2023 April | 23 | 17 | 40 |
| 2023 March | 36 | 21 | 57 |
| 2023 February | 31 | 27 | 58 |
| 2023 January | 27 | 16 | 43 |
| 2022 December | 53 | 33 | 86 |
| 2022 November | 41 | 23 | 64 |
| 2022 October | 67 | 20 | 87 |
| 2022 September | 36 | 28 | 64 |
| 2022 August | 32 | 35 | 67 |
| 2022 July | 28 | 25 | 53 |
| 2022 June | 30 | 26 | 56 |
| 2022 May | 25 | 38 | 63 |
| 2022 April | 36 | 32 | 68 |
| 2022 March | 33 | 40 | 73 |
| 2022 February | 28 | 29 | 57 |
| 2022 January | 47 | 34 | 81 |
| 2021 December | 23 | 35 | 58 |
| 2021 November | 23 | 38 | 61 |
| 2021 October | 36 | 42 | 78 |
| 2021 September | 35 | 59 | 94 |
| 2021 August | 17 | 29 | 46 |
| 2021 July | 17 | 19 | 36 |
| 2021 June | 12 | 13 | 25 |
| 2021 May | 28 | 40 | 68 |
| 2021 April | 67 | 59 | 126 |
| 2021 March | 50 | 30 | 80 |
| 2021 February | 2 | 2 | 4 |
| 2020 September | 2 | 3 | 5 |
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