[A history of joint puncture and injection]. / Gelenkpunktion und -injektion - Die Geschichte.

Up until the middle of the 20th century joint puncture was considered a dangerous surgical intervention performed primarily to drain pus. The differential diagnostic significance of synovial analysis only became clear in the second half of the 20th century. Thus it became possible to reliably distinguish between inflammatory and non-inflammatory diseases, and establish whether arthritides are bacterial or crystal-induced. Attempts to inject disinfecting or anti-inflammatory solutions into the joint go back to the end of the 19th century. In the mid 20th century, cortisone became the panacea of intraarticular therapy. After surgeons at the end of the 19th century succeeded in surgically removing the inflamed synovium, internal medicine specialists attempted to destroy the synovial membrane by injecting it with various chemicals around the mid 20th century; however, hardly any of these substances survived. Only with "internal radiation" by injecting radionuclides was a breakthrough seen in the middle of the 20th century. Since then radiosynoviorthesis and synovialectomy have become standard methods in the treatment of chronic inflammatory joint disease.

[On the main stages of the history of intra-articular therapy]. / Sulla storia delle terapie intra-articolari. Le tappe principali.

In this review the main stages in the history of intra-articular therapy of the rheumatic diseases are summarized. The first approach to such a local treatment has been likely performed in 1792 by the French physician Jean Gay, who injected in a swelling knee the "eau du Goulard" (Goulard's water), namely a mixture based on lead compounds. In the XIX century iodine derivatives have been mainly applied as an intra-articular treatment. In the XX century, before the wide use of intra-articular corticosteroids, chiefly due to the Joseph Lee Hollander's experiences, a variety of drugs has been employed, including cytostatics and sclerosing substances. A further important stage has been synoviorthesis, by using specific radionuclides, that would actually represent an anti-synovial treatment. In the last years a spread use of intra-articular hyaluronic acid, particularly in osteoarthritis, has been recorded, with the aim to warrant articular viscosupplementation. Future of intra-articular treatment should be represented by the biological drugs, i.e., anti-TNF, but it is still untimely to define the exact role of such a local treatment of arthritis.