Local Steroid Therapy in Painful Orthopaedic Conditions

Local corticosteroid therapy is often used in the treatment of a variety of painful orthopaedic conditions such as rheumatoid arthritis, osteoarthritis, peritendinitis, tendinous and ligamentous disorders and bursitis.

Steroids have a direct biological activity of two kinds one pertaining to tissue repair, the other to tissue destruction. All tissue components, vessels, cellular compartment and ground substance are affected by steroids. The most important role of these agents in repair is their anti-inflammatory property. They can however be shown to destroy the fundamental building stones of connective tissue, cartilage and bone. This destructive action appears to be dose-dependent.

Clinical appraisal varies. Both beneficial and deleterious effects have been noted. Local steroid therapy has a part to play in rheumatoid arthritis and in soft tissue disorders, but would appear to be of questionable value in patients with osteoarthritis.