Absorption of hydrocortisone from the joint cavity into the circulation.

Intra-articular hydrocortisone therapy has been in extensive use for approximately 5 years. It has been stated that this therapy is strictly for local palliation and has no systemic effects (Hollander, 1953). Local hydrocortisone therapy is especially recommended in cases in which the systemic use of cortisone is contra-indicated on general medical grounds (Kersley, 1953). On the other hand, Young, Ward, and Henderson (1952) noted clinically systemic as well as local effects after intra-articular injections of hydrocortisone acetate in 31 (21 per cent.) of their 148 patients. There was clinical improvement in involved but uninjected joints in this group, the effect being similar in nature, both subjectively and objectively, to that which results from the oral or intramuscular administration of cortisone. Its occurrence indicates that at least part of the hydrocortisone acetate injected into the synovial cavity is absorbed into the blood stream and reaches the general circulation. In a study of the intra-articular metabolism of hydrocortisone and cortisone (Wilson, Fairbanks, McEwen, and Ziff, 1955), it was found that hydrocortisone acetate disappeared rapidly from the synovial fluid after intra-articular injection. After