Corticosteroid Injections Plus Exercise Ease Achilles Tendinopathy

It is unclear whether disease control prevents RA-related bone loss, but data suggest it does in patients with early RA and high disease activity.1 Two systemic analyses of RA studies concluded that biologic DMARDs reduce generalized and localized bone loss.2,19 However, few studies were phase 3 trials, and most measured markers of bone turnover.2,19 High-quality trials that measure BMD change or fracture risk are needed. Bisphosphonates, denosumab, and parathyroid hormone are agents approved for osteoporosis and glucocorticoid-induced osteoporosis. Bisphosphonates and denosumab appear to have similar efficacy at preserving BMD.1 In some RA studies, denosumab also prevented and repaired erosions.2 The ACR guidelines for glucocorticoid-induced osteoporosis categorize patients as having low, moderate, or high fracture risk.18 They recommend calcium (1000 to 1200 mg/d) and vitamin D (600 to 800 IU/d) supplements for all patients, plus an osteoporosis agent (preferably an oral bisphosphonate) for patients with moderate to high fracture risk.

It is unclear whether disease control prevents RA-related bone loss, but data suggest it does in patients with early RA and high disease activity.1 Two systemic analyses of RA studies concluded that biologic DMARDs reduce generalized and localized bone loss.2,19 However, few studies were phase 3 trials, and most measured markers of bone turnover.2,19 High-quality trials that measure BMD change or fracture risk are needed. Bisphosphonates, denosumab, and parathyroid hormone are agents approved for osteoporosis and glucocorticoid-induced osteoporosis. Bisphosphonates and denosumab appear to have similar efficacy at preserving BMD.1 In some RA studies, denosumab also prevented and repaired erosions.2

The ACR guidelines for glucocorticoid-induced osteoporosis categorize patients as having low, moderate, or high fracture risk.18 They recommend calcium (1000 to 1200 mg/d) and vitamin D (600 to 800 IU/d) supplements for all patients, plus an osteoporosis agent (preferably an oral bisphosphonate) for patients with moderate to high fracture risk.

The combination of corticosteroid injections and exercise therapy helps reduce symptoms of long-standing Achilles tendinopathy.

HealthDay News — The combination of corticosteroid injections and exercise therapy helps reduce symptoms of long-standing Achilles tendinopathy, according to a study published online July 11 in JAMA Network Open.

In a participant-blinded, physician-blinded, and assessor-blinded randomized clinical trial of patients with Achilles tendinopathy verified by ultrasonography, Finn Johannsen, M.D., from Bispebjerg Hospital in Copenhagen, Denmark, and colleagues evaluated the effect of corticosteroid injection and exercise therapy (48 patients) compared to placebo injection and exercise therapy (52 patients) for patients with Achilles tendinopathy.

The researchers found that at six months, the group receiving exercise therapy combined with corticosteroid injections had a 17.7-point larger improvement in Victorian Institute of Sports Assessment-Achilles scores compared with patients receiving exercise therapy combined with placebo injections. Neither group showed severe adverse events or deterioration during two years of follow-up.

“The present study adds to the current knowledge and suggests that corticosteroid injection can play a valuable role in the management of long-standing Achilles tendinopathy when combined with exercise therapy,” the authors write. “A combination of exercise therapy and corticosteroid injection should be considered in the management of long-standing Achilles tendinopathy.”

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