What is the recommended steroid for intra-articular (in the joint) injection in a patient's knee?

From the Guidelines

Methylprednisolone is the recommended steroid for intra-articular injection in a patient's knee, as it has been shown to improve knee pain and function at 4 and 24 weeks 1. When considering intra-articular corticosteroid injections for knee osteoarthritis, the following points are important:

• Methylprednisolone and triamcinolone have both been found to reduce joint pain and improve function in OA-related knee pain, but methylprednisolone has a more sustained effect 1.
• The effects of intra-articular corticosteroids are time-limited, with no long-term improvement at 2-year follow-up 1.
• Intra-articular corticosteroid injections can be beneficial for patients with persistent OA-related knee pain, but providers must consider the potential long-term negative effects on bone health, joint structure, and meniscal thickness associated with repeat administration 1.
• The injection should be performed using aseptic technique, and patients should be informed of the potential risks and benefits, including the possibility of a temporary flare of pain for 24-72 hours.
• Injections should generally be limited to minimize potential adverse effects such as cartilage damage, infection risk, or systemic steroid absorption. Key considerations for intra-articular corticosteroid injections in the knee include:
• Using aseptic technique to minimize the risk of infection
• Aspirating any joint effusion prior to injection
• Limiting the number of injections per year to minimize potential adverse effects
• Informing patients of the potential risks and benefits, including the possibility of a temporary flare of pain.

From the FDA Drug Label

The dose for intra-articular administration depends upon the size of the joint and varies with the severity of the condition in the individual patient. In chronic cases, injections may be repeated at intervals ranging from one to five or more weeks, depending upon the degree of relief obtained from the initial injection The doses in the following table are given as a general guide: Size of JointExamplesRange of Dosage Large Knees Ankles Shoulders 20 to 80 mg Medium Elbows Wrists 10 to 40 mg Small Metacarpophalangeal Interphalangeal Sternoclavicular Acromioclavicular 4 to 10 mg

The recommended steroid for intra-articular injection in a patient's knee is methylprednisolone or betamethasone.

• For methylprednisolone, the dose is 20 to 80 mg.
• For betamethasone, the dose is 1 mL. 2 3

From the Research

Recommended Steroids for Intra-Articular Injection in the Knee

The following steroids have been studied for intra-articular injection in the knee:

• Triamcinolone acetonide (TA) 4, 5, 6
• Triamcinolone hexacetonide (TH) 7, 6
• Methylprednisolone acetate (MPA) 5
• Betamethasone 7
• Hydrocortisone succinate (HC) 6

Comparison of Steroids

Studies have compared the efficacy of different steroids for intra-articular injection in the knee:

• TA 10 mg was found to be non-inferior to TA 40 mg in improving pain in patients with symptomatic knee osteoarthritis 4
• TH was found to be more effective than betamethasone in reducing pain and improving joint range in patients with osteoarthrosis of the knee joint 7
• MPA and TA were found to have similar efficacy in reducing pain and swelling in patients with chronic inflammatory arthritis 5
• TH was found to be more effective than TA and HC in providing pain relief in patients with rheumatoid knees 6

Dosage and Frequency

The optimal dosage and frequency of intra-articular steroid injections in the knee are still debated:

• A study recommended refining and individually tailoring the selection of agent and dosing regimen to patient needs and clinical response 8
• Different studies have used varying doses of TA, ranging from 10 mg to 40 mg 4, and MPA, ranging from 80 mg 5