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Varela-Margolles D, Milani A, Kamel SI. Percutaneous Interventions for Injuries in Athletes: Implications on Return to Play. Semin Musculoskelet Radiol 2024; 28:146-153. [PMID: 38484767 DOI: 10.1055/s-0043-1778026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
For nonsurgical musculoskeletal (MSK) injuries in athletes, image-guided percutaneous intervention may aid in recovery and decrease return to play (RTP) time. These interventions fall into two major categories: to reduce inflammation (and therefore alleviate pain) or to promote healing. This review describes the risks and benefits of the various percutaneous interventions in MSK athletic injury and surveys the literature regarding the implication of these interventions on RTP.
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Affiliation(s)
- Diana Varela-Margolles
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ava Milani
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah I Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Kamel SI, Rosas HG, Gorbachova T. Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications. AJR Am J Roentgenol 2024; 222:e2330458. [PMID: 38117096 DOI: 10.2214/ajr.23.30458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Corticosteroid injections can be associated with a range of potential side effects, which may be classified as local or systemic and further stratified as immediate or delayed in onset. Radiologists performing image-guided musculoskeletal injections should recognize the potential side effects of corticosteroid medication when counseling patients before injection and consider such side effects in planning individual injections. This Review summarizes the available evidence regarding the local and systemic side effects of corticosteroid injections performed for musculoskeletal indications. Local side effects include postinjection flare, skin hypopigmentation and atrophy, infection, tendon rupture, accelerated progression of osteoarthritis, and osseous injury. Systemic side effects include adrenal suppression or insufficiency, facial flushing, hypertension, hyperglycemia, and osteoporosis. Additional targeted counseling is warranted regarding side effects that are specific to certain patient populations (i.e., premenopausal women, patients with diabetes, athletes, and pediatric patients). Corticosteroid injections are contraindicated in the presence of superficial or deep infection, fracture, or a prosthetic joint. Guidelines on the frequency, duration, and maximal lifetime use of corticosteroid injections are currently lacking. Further research is needed regarding the long-term complications of continuous corticosteroid use, particularly with regard to osseous effects.
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Affiliation(s)
- Sarah I Kamel
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107
| | - Humberto G Rosas
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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He T, Song T. Exercise-induced bronchoconstriction in elite athletes: a narrative review. PHYSICIAN SPORTSMED 2023; 51:549-557. [PMID: 36373406 DOI: 10.1080/00913847.2022.2148137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is the most common chronic disease among elite athletes and when left untreated, can impact both respiratory health and sports performance. In recent years, there has been an increase in the awareness and detection of EIB in elite athletes. This narrative review aims to evaluate the risk, prevention, diagnosis, medication, and anti-doping policies of EIB in elite athletes, and to provide more references for athletes with EIB. The results showed that athletes of endurance, winter, and water sports generally have a higher prevalence of EIB than athletes of other sports. Adaptive warm-up before formal exercise and using heat exchange masks at low temperatures are effective ways for athletes to prevent EIB. For physicians, the exercise challenge test and eucapnic voluntary hyperpnea are the recommended diagnostic methods for EIB in athletes. The treatment of athletes with EIB is medication-based, such as inhaled corticosteroids and beta-2 agonists, but current anti-doping policies should be considered when used.
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Affiliation(s)
- Tianchang He
- Department of research, Shenyang Sport University, Shenyang, Liaoning, China
| | - Tienan Song
- Department of research, Shenyang Sport University, Shenyang, Liaoning, China
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4
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McMorrow K, Allahabadi S, Frazier L, Quigley R, Serrano B, Cole BJ. One to Two Days of Rest Is Recommended Before Returning to Sport After Intra-Articular Corticosteroid Injection in the High-Level Athlete. Arthrosc Sports Med Rehabil 2023; 5:100763. [PMID: 37560144 PMCID: PMC10407144 DOI: 10.1016/j.asmr.2023.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023] Open
Abstract
UNLABELLED Return to sport following a corticosteroid injection is a complex decision. Multiple considerations should be taken into account, including steroid dose and formulation, involvement of the affected joint in the activity, and intensity of the activity. Research investigating the adverse effects of corticosteroid injections with early initiation of high-intensity activity is limited and has produced mixed results. Rest following injections has typically been recommended to minimize both chondrotoxic effects and systemic absorption. Based on the current research and extensive experience treating professional athletes, we recommend 1 to 2 days of rest of the affected joint or region with a progressive increase of activity following a corticosteroid injection with possible benefits including maximizing the beneficial effects of the injection and a reduced systemic effect. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | | | | | - Ryan Quigley
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | | | - Brian J. Cole
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
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Nordsborg NB, Bonne TC, Breenfeldt Andersen A, Sørensen H, Bejder J. Glucocorticoids Accelerate Erythropoiesis in Healthy Humans-Should the Use in Sports Be Reevaluated? Med Sci Sports Exerc 2023; 55:1334-1341. [PMID: 36878016 DOI: 10.1249/mss.0000000000003156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE The World Anti-Doping Agency prohibits glucocorticoid administration in competition but not in periods out of competition. Glucocorticoid usage is controversial as it may improve performance, albeit debated. A hitherto undescribed but performance-relevant effect of glucocorticoids in healthy humans is accelerated erythropoiesis. We investigated whether a glucocorticoid injection accelerates erythropoiesis, increases total hemoglobin mass, and improves exercise performance. METHODS In a counterbalanced, randomized, double-blinded, placebo-controlled crossover design (3 months washout), 10 well-trained males (peak oxygen uptake, 60 ± 3 mL O 2 ·min -1 ·kg -1 ) were injected with 40 mg triamcinolone acetonide (glucocorticoid group) or saline (placebo group) in the gluteal muscles. Venous blood samples collected before and 7-10 h, 1, 3, 7, 14, and 21 d after treatment were analyzed for hemoglobin concentration and reticulocyte percentage. Hemoglobin mass and mean power output in a 450-kcal time trial were measured before as well as 1 and 3 wk after treatment. RESULTS A higher reticulocyte percentage was evident 3 d (19% ± 30%, P < 0.05) and 7 d (48% ± 38%, P < 0.001) after glucocorticoid administration, compared with placebo, whereas hemoglobin concentration was similar between groups. Additionally, hemoglobin mass was higher ( P < 0.05) 7 d (glucocorticoid, 886 ± 104 g; placebo, 872 ± 103 g) and 21 d (glucocorticoid, 879 ± 111 g; placebo, 866 ± 103 g) after glucocorticoid administration compared with placebo. Mean power output was similar between groups 7 d (glucocorticoid, 278 ± 64 W; placebo, 275 ± 62 W) and 21 d (glucocorticoid, 274 ± 62 W; placebo, 275 ± 60 W) after treatment. CONCLUSIONS Intramuscular injection of 40 mg triamcinolone acetonide accelerates erythropoiesis and increases hemoglobin mass but does not improve aerobic exercise performance in the present study. The results are important for sport physicians administering glucocorticoids and prompt a reconsideration of glucocorticoid usage in sport.
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Affiliation(s)
| | - Thomas Christian Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | | | - Henrik Sørensen
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
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Norman MB, Norman ER, Langer GH, Allen MR, Meller L, Vitale KC. Return to Sport Using Corticosteroid Injections for Knee Pain in Triathletes. Cureus 2023; 15:e39985. [PMID: 37416041 PMCID: PMC10321459 DOI: 10.7759/cureus.39985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Despite the prevalence of corticosteroid injections in athletes, little is known about their efficacy in triathletes. We aim to assess attitudes, use, subjective effectiveness, and time to return to sport with corticosteroid injections compared to alternative methods in triathletes with knee pain. Methods This is an observational study during the COVID-19 pandemic. Triathletes answered a 13-question survey posted to three triathlon-specific websites. Results Sixty-one triathletes responded, 97% of whom experienced knee pain at some point in their triathlete career; 63% with knee pain received a corticosteroid injection as treatment (average age 51 years old). The most popular attitude (44.3%) regarding corticosteroid injections was "tried them, with good improvement". Most found the cortisone injection helpful for two to three months (28.6%), or more than one year (28.6%); of individuals who found the injections useful for more than one year, four-eight (50%) had received multiple injections during that same period. After injection, 80.6% returned to sport within one month. The average age of people using alternative treatment methods was 39 years old; most returned to sport within one month (73.7%). Compared to alternative methods, there was an ~80% higher odds of returning to sport within one month using corticosteroid injections; however, this relationship was not significant (OR=1.786, p=0.480, 95% CI:0.448-7.09). Conclusion This is the first study to examine corticosteroid use in triathletes. Corticosteroid use is more common in older triathletes and results in subjective pain improvement. A strong association does not exist for a quicker return to sport using corticosteroid injections compared to alternative methods. Triathletes should be counseled on the timing of injections, duration of side effects, and be aware of potential risks.
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Affiliation(s)
| | - Emily R Norman
- Physical Medicine and Rehabilitation, Dartmouth Geisel School of Medicine, Hanover, USA
| | | | - Matthew R Allen
- Orthopedic Surgery, University of California San Diego School of Medicine, La Jolla, USA
| | - Leo Meller
- Orthopedic Surgery, University of California San Diego School of Medicine, La Jolla, USA
| | - Kenneth C Vitale
- Orthopedic Surgery, University of California San Diego School of Medicine, La Jolla, USA
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Allado E, Poussel M, Gambier N, Saunier V, Starck M, Buisson C, Cinquetti G, Albuisson E, Chenuel B. SporTRIA study-a multicentre trial protocol for excretion kinetics of triamcinolone acetonide following sport-related intra-articular injections in knees: definitions of the washout periods. BMJ Open 2021; 11:e047548. [PMID: 34108168 PMCID: PMC8191621 DOI: 10.1136/bmjopen-2020-047548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intra-articular (IA) and peri-articular glucocorticoid (GC) injections are common in sports medicine. However, from 1 January 2022, all injectable GC routes (including IA administration) will be prohibited in-competition by World Anti-Doping Agency (WADA). Owing to these rules, an IA GC treatment out-of-competition could result in an adverse analytical finding in-competition if the washout period is not clearly defined. The aim of this study is to determine the urinary excretion profile of triamcinolone acetonide following IA injection to strengthen the definition of the washout periods. METHODS AND ANALYSIS This is a prospective multicentre trial to include 20 subjects who practice sports for at least 4 hours/week and present a knee disorder requiring IA injection of triamcinolone acetonide for therapeutic purposes. To determine the excretion profile of triamcinolone acetonide in both urine and blood following IA injection of the drug, We will perform 20 urinary tests and 20 dried blood spot tests, two prior to GC injection (baseline) and the last one at 35 days. Analyses will be performed by the French antidoping agency laboratory in accordance with WADA standards and regulations. ETHICS AND DISSEMINATION The study protocol was approved by the French ethics committee (CPP Sud Est III-Lyon-2020-070B on 06 October 2020). All subjects will provide written informed consent. The results of this study will be accessible in peer-reviewed publication and be presented at academic conference. TRIAL REGISTRATION NUMBER NCT04574232.
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Affiliation(s)
- Edem Allado
- Université de Lorraine, CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
- Université de Lorraine, DevAH, Université de Lorraine, Nancy, Lorraine, France
| | - Mathias Poussel
- Université de Lorraine, CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
- Université de Lorraine, DevAH, Université de Lorraine, Nancy, Lorraine, France
| | - Nicolas Gambier
- Université de Lorraine, CHRU-Nancy Department of Clinical Pharmacology and Toxicology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
- Université de Lorraine, CNRS, IMoPA, Université de Lorraine, Nancy, Lorraine, France
| | - Véronique Saunier
- CHRU-Nancy, Direction de la Recherche Clinique et de l'Innovation, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
| | - Marjorie Starck
- CHRU-Nancy, Direction de la Recherche Clinique et de l'Innovation, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
| | - Corinne Buisson
- Département des Analyses, AFLD, AFLD, Chatenay-Malabry, Île-de-France, France
| | - Gael Cinquetti
- Service des Maladies Infectieuses et Systémiques, Hôpital d'Instruction des Armées Legouest, Metz, Lorraine, France
| | - Eliane Albuisson
- CHRU-Nancy, Direction de la Recherche Clinique et de l'Innovation, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
- Université de Lorraine, CNRS, IECL, Université de Lorraine, Nancy, Lorraine, France
| | - Bruno Chenuel
- Université de Lorraine, CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, Centre Hospitalier Régional Universitaire de Nancy, Nancy, Lorraine, France
- Université de Lorraine, DevAH, Université de Lorraine, Nancy, Lorraine, France
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McClure S, Fenger C, Kersh K, Brown B, Maylin G, Duer W, Dirikolu L, Brewer K, Machin J, Tobin T. Dexamethasone serum concentrations after intravenous administration in horses during race training. COMPARATIVE EXERCISE PHYSIOLOGY 2021. [DOI: 10.3920/cep200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dexamethasone (DXM) sodium phosphate is a widely used corticosteroid for inflammatory conditions in horses, regulated in racing jurisdictions in the USA by a 0.005 ng/ml serum/plasma threshold. This study seeks to describe serum concentrations of DXM at 48 and 72 h after intravenous administration of 20 mg DXM sodium phosphate over 1 to 5 days, and to identify a possible source of DXM overages. 74 horses (39 Thoroughbreds, 13 Standardbreds, 22 Quarter Horses) in active race training received 20 mg DXM sodium phosphate. Serum was collected before injection, at 48 and 72 h post last injection, and analysed by LC/MS-MS (limit of quantification (LOQ) = 2.5 pg/ml). No differences were identified by ANOVA (P≤0.05) for racing breeds, age, gender or the number of days of DXM sodium phosphate administration, so data were pooled for each time point. The DXM serum concentration at 48 h (mean ± standard deviation, range) was 2.18±1.56 pg/ml (<2.5 to 40 pg/ml). Summary statistics could not be derived for 72 h DXM serum concentration data owing to censored data, but ranged from <2.5 to 95.8 pg/ml. There was one extreme outlier (Tukey) at 48 h, and two extreme outliers at 72 h. A separate study was conducted using sedentary experimental horses to determine the likelihood that positive DXM samples could result from environmental transfer. Urine was collected from a mare 2 to 3 h post administration of 20 mg DXM. Hay with 100 ml of the DXM (17 ng/ml) containing urine was offered to each of six experimental horses and blood was collected at 0, 4, 8, 12, 16, 20 and 24 h. All six horses had plasma DXM concentration above the limit of detection and five of six had plasma DXM concentrations above the LOQ for at least one sample time.
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Affiliation(s)
- S. McClure
- Midwest Equine Surgery and Sports Medicine, 2615 Eastgate Drive, Boone, IA 50036, USA
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University, 1800 Christensen Drive, Ames, IA 50011-1134, USA
| | - C. Fenger
- Equine Integrated Medicine, PLC, 4904 Ironworks Rd., Georgetown, KY 40324, USA
| | - K. Kersh
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University, 1800 Christensen Drive, Ames, IA 50011-1134, USA
| | - B. Brown
- Bradley Brown, private practice, 425 Sacree Rd., Shelbyville, KY 40065, USA
| | - G. Maylin
- New York Drug Testing and Research Program, Morrisville State College, 777 Warren Rd, Ithaca, NY 14853, USA
| | - W. Duer
- Duer Forensic Toxicology LLC., 1621 Gulf Blvd #102, Clearwater, FL 33767-2928, USA
| | - L Dirikolu
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803, USA
| | - K. Brewer
- Kimberly Brewer, private practice, 15775 Cypress Creek Lane, Wellington, FL 33414, USA
| | - J. Machin
- The Maxwell H. Gluck Equine Research Center, University of Kentucky, 1400 Nicholasville Rd, Lexington, KY 40503, USA
| | - T. Tobin
- The Maxwell H. Gluck Equine Research Center, University of Kentucky, 1400 Nicholasville Rd, Lexington, KY 40503, USA
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Vernec A, Slack A, Harcourt PR, Budgett R, Duclos M, Kinahan A, Mjøsund K, Strasburger CJ. Glucocorticoids in elite sport: current status, controversies and innovative management strategies-a narrative review. Br J Sports Med 2019; 54:8-12. [PMID: 31326919 PMCID: PMC6923944 DOI: 10.1136/bjsports-2018-100196] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/08/2023]
Abstract
The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.
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Affiliation(s)
- Alan Vernec
- Department of Science and Medicine, WADA, Montreal, Quebec, Canada
| | - Andrew Slack
- Medical Affairs, Exactis Innovation, Montreal, Quebec, Canada
| | - Peter Rex Harcourt
- Department of Integrity, Australian Rules Football League (AFL), Melbourne, Victoria, Australia
| | | | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France
| | | | | | - Christian J Strasburger
- Endocrinology, Diabetes and Nutritional Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
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10
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Coll S, Matabosch X, Llorente-Onaindia J, Carbó ML, Pérez-Mañá C, Monfort N, Monfort J, Ventura R. Elimination profile of triamcinolone hexacetonide and its metabolites in human urine and plasma after a single intra-articular administration. Drug Test Anal 2019; 11:1589-1600. [PMID: 31087549 DOI: 10.1002/dta.2614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/11/2022]
Abstract
Triamcinolone hexacetonide (THA) is a synthetic glucocorticoid (GC) used by intra-articular (IA) administration. GCs are prohibited in sports competitions by systemic routes, and they are allowed by other routes considered of local action (IA administration, among others). The aim of the present work was to study the metabolic profile of THA in urine and plasma following IA administration. Eight patients (4 males and 4 females) with knee osteoarthritis received an IA dose of THA (40 mg) in the knee joint. Spot urine and plasma samples were collected before injection and at different time periods up to day 23 and 10 post-administration, respectively. The samples were analysed by liquid chromatography-tandem mass spectrometry. Neither THA nor specific THA metabolites were detected in urine. Triamcinolone acetonide (TA) and 6β-hydroxy-triamcinolone acetonide were the main urinary metabolites. Maximum concentrations wereobtained between 24 and 48 h after administration. Using the reporting level of 30 ng/mL to distinguish allowed from forbidden administrations of GCs, a large number of false adverse analytical findings would be reported up to day 4. On the other hand, TA was detected in all plasma samples collected up to day 10 after administration. THA was also detected in plasma but at lower concentrations. The detection of plasma THA would be an unequivocal proof to demonstrate IA use of THA. A reversible decrease was observed in plasma concentrations of cortisol in some of the patients, indicating a systemic effect of the drug.
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Affiliation(s)
- Sergi Coll
- IMIM (Hospital del Mar Medical Research Institute), Catalonian Antidoping Laboratory, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Matabosch
- IMIM (Hospital del Mar Medical Research Institute), Catalonian Antidoping Laboratory, Barcelona, Spain
| | - Jone Llorente-Onaindia
- IMIM (Hospital del Mar Medical Research Institute), Cell Research on Inflammation and Cartilage Group, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Rheumatology Department, Barcelona, Spain
| | - Marcel Li Carbó
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Clara Pérez-Mañá
- Hospital Universitari Germans Trias i Pujol (IGTP), Department of Clinical Pharmacology, Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Nuria Monfort
- IMIM (Hospital del Mar Medical Research Institute), Catalonian Antidoping Laboratory, Barcelona, Spain
| | - Jordi Monfort
- IMIM (Hospital del Mar Medical Research Institute), Cell Research on Inflammation and Cartilage Group, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Rheumatology Department, Barcelona, Spain
| | - Rosa Ventura
- IMIM (Hospital del Mar Medical Research Institute), Catalonian Antidoping Laboratory, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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11
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Abstract
OBJECTIVE To review the literature guiding all aspects of the use of injectable corticosteroids for painful musculoskeletal conditions, with a focus on the treatment of athletes. DATA SOURCES An extensive search of the literature was completed including search terms of corticosteroid, steroid, athlete, and injection, among others. Additional articles were used after being identified from previously reviewed articles. MAIN RESULTS Injections of corticosteroids for a variety of painful conditions of the extremities and the axial spine have been described. Numerous minor and major complications have been reported, including those with a high degree of morbidity. There is a dearth of published research on the use of corticosteroid injections in athletes, with most of the research on this topic focused on older, nonathlete populations. Generally, these injections are well tolerated and can provide short-term pain improvement with little or no long-term benefits. CONCLUSIONS Corticosteroid injections should be used cautiously in athletes and only after a full consideration of the pharmacology, pathogenesis of disease, potential benefits, complications, factors specific to the athlete, and rules of athletic governing bodies. Corticosteroid injections are just one component of a comprehensive rehabilitation plan available to the physician providing care to athletes.
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12
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Thevis M, Kuuranne T, Geyer H. Annual banned-substance review: Analytical approaches in human sports drug testing. Drug Test Anal 2017; 10:9-27. [DOI: 10.1002/dta.2336] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses; University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne; Epalinges Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
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13
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Allen M, Stuart MC, Gribble H, Budgett R, Pipe A. Needle-use declarations at the Olympic Games Rio 2016. Br J Sports Med 2017; 52:747-752. [PMID: 29162621 DOI: 10.1136/bjsports-2017-098294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/03/2022]
Abstract
AIM We report on the results of the 'IOC Needle Policy' applied during the course of the Games of the XXXI Summer Olympiad in Rio de Janeiro, Brazil. The policy was intended to empower physicians to ensure appropriate clinical use of needles within team medical environments, enhance the safety of those responsible for housekeeping services and others in the Olympic environment, and permit documentation of such procedures as an adjunct to the doping control programme. Any needle use required the submission of an 'Injection Declaration Form' to IOC medical officials. METHOD All 'Injection Declaration Forms' were reviewed and archived. The declarations provided basic information regarding the nature of the needle use and the product(s) involved, the physician, athlete and respective National Olympic Committee (NOC). The details of the declarations were subsequently categorised. RESULTS A total of 367 declarations were received from physicians representing 49 NOCs. Needle-use declarations were more common in athletics, gymnastics, football and aquatics. A single product was administered in 60% of the cases, and more than one product was administered in 40%. The majority of declarations indicated the use of local anaesthetics, glucocorticoids, non-steroidal anti-inflammatory drugs and analgesics. CONCLUSION The introduction of a 'Needle Policy' in the Olympic Games setting was intended to minimise the use of needles by non-physicians, promote evidence-based practice and to deter needle-based doping practices. Declarations were received from 49 of 209 NOCs suggesting either that needle use is minimal among certain teams or opportunities remain to enhance compliance with such policies at future games.
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Affiliation(s)
- Molly Allen
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Campbell Stuart
- Member IOC Medical Commission Games Medical Group, Rio 2016.,BMJ Learning, BMJ Group, London, UK
| | - Hannah Gribble
- United Kingdom Anti-Doping Organization, London, England
| | | | - Andrew Pipe
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Member IOC Medical Commission Games Medical Group, Rio 2016.,Division of Prevention & Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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