Tender shins and steroid therapy

To quantify previously described shin tenderness in patients receiving chronic steroid therapy, we studied 54 patients, 26 treated with steroid, by dolorimetry at 4 control, 4 'fibrositic,' and 4 shin sites. To measure observer variation, assessments were done by 2 or 3 of 10 observers, one of whom examined each subject. The specific increase of tenderness at shin sites associated with steroid therapy was confirmed, with a mean (SD) threshold in the steroid group of 3.0 (1.7) kg, and in the control group 5.6 (2.4). Other effects which were not site specific were found. There was a 2.0 kg increase in control site tenderness associated with steroid therapy, and a similar general increase in tenderness in patients with lupus and in women, independent of steroid therapy, affecting control as well as fibrositic sites. Underlying mechanisms must act generally as well as being site specific.