RESUMEN
Pain caused by subcutaneous injections is unpleasant, which may limit patient compliance. The objective of this study was to use spinal reflexes to quantify subcutaneous injection pain. Spinal reflexes were measured using an electromyogram (EMG) test. The effects of injection volume, pH and osmotic pressure were investigated. The EMG responses increased with injection volume and the acidity of the solution but did not depend on the osmotic pressure of the solution. The EMG responses differed for subcutaneously injected sodium chloride and glucose over the same range of osmotic pressures. Pain caused by the subcutaneous injections was unrelated to the osmotic ratio up to approximately 5. The injection pain caused by therapeutic protein solutions was also evaluated. We compared the EMG responses of the adalimumab and etanercept, as the injection of adalimumab is more painful than that of etanercept in humans. The EMG magnitude for adalimumab was twice that induced by etanercept as observed for the EMG tests performed in rats. Therapeutic proteins account for an increasingly large proportion of pharmaceutical drugs. When a high dose of therapeutic proteins is required, the protein solution must often be highly concentrated to reduce the injection volume. For patient comfort, it is critical to reduce injection pain. The EMG test reported here allows subcutaneous injection pain to be quantified and may be useful for optimizing drug formulations.
Asunto(s)
Adalimumab/efectos adversos , Antirreumáticos/efectos adversos , Modelos Animales de Enfermedad , Etanercept/efectos adversos , Dolor/inducido químicamente , Nervios Espinales/efectos de los fármacos , Tejido Subcutáneo/efectos de los fármacos , Adalimumab/administración & dosificación , Animales , Antirreumáticos/administración & dosificación , Electrodos Implantados , Electromiografía , Etanercept/administración & dosificación , Pie , Humanos , Concentración de Iones de Hidrógeno , Inyecciones Subcutáneas , Masculino , Presión Osmótica , Dimensión del Dolor , Ratas Sprague-Dawley , Reflejo/efectos de los fármacos , Tejido Subcutáneo/inervación , MusloRESUMEN
Cogan's syndrome is characterized by non syphilitic interstitial keratitis and Meniere's syndrome-like audiovestibular function disorder, as well as various systemic manifestations, including fever, arthralgia, vasculitis, and aortitis. We report the case of atypical Cogan's syndrome with aortitis; the patient's symptoms caused by active inflammation, including inflammatory ocular manifestations, audiovestibular symptoms, and aortitis, were improved by early administration of corticosteroids, however, her reduced visual acuity was not improved because of post-inflammatory change in her left eye.