Can methylprednisolone (Medrol) be used for intra-articular joint injections?

From the Guidelines

Methylprednisolone can be used for intra-articular joint injections to reduce joint pain and improve function in osteoarthritis-related knee pain, as evidenced by a 2021 study published in the Mayo Clinic Proceedings 1.

Key Points to Consider

• Intra-articular corticosteroids, including methylprednisolone, have been found to reduce joint pain and improve function in OA-related knee pain, with effects lasting up to 24 weeks 1.
• The use of methylprednisolone for intra-articular injections is supported by the 2021 clinical practice guideline for the non-surgical management of hip and knee osteoarthritis, which suggests offering corticosteroid injections in patients with persistent knee and/or hip OA pain 1.
• Typical preparations of methylprednisolone for intra-articular injections include Depo-Medrol (methylprednisolone acetate), available in concentrations of 20,40, and 80 mg/mL.
• Doses for large joints like the knee typically range from 20-80 mg, while smaller joints may receive 10-40 mg.
• The onset of action is usually within 24-48 hours, and the effects can last from several days to months, depending on the individual and condition being treated.
• Before injection, the area should be properly cleaned and sterilized, and the procedure should be performed using aseptic technique.
• Local anesthetic like lidocaine is often mixed with the steroid for immediate pain relief.
• Patients should be informed that they might experience a temporary flare of pain for 24-48 hours after the injection.
• Methylprednisolone works by suppressing inflammatory mediators and reducing immune system activity locally in the joint, which decreases inflammation, swelling, and pain.
• Injections are typically limited to 3-4 per year in the same joint to minimize potential side effects such as cartilage damage, tendon weakening, or systemic absorption.

Important Considerations

• The 2021 study published in the Mayo Clinic Proceedings found that intra-articular corticosteroid injections, including methylprednisolone, were beneficial for patients with persistent OA-related hip pain, but required image guidance to ensure safety 1.
• The study also noted that few adverse events were reported from either knee or hip corticosteroid injections when compared with placebo at 6 months, but providers must take into account the potential long-term negative effects on bone health, joint structure, and meniscal thickness associated with repeat intra-articular corticosteroid administration 1.
• The 2012 American College of Rheumatology guidelines for management of gout also recommend the use of intra-articular corticosteroids, including methylprednisolone, for acute gouty arthritis, but do not provide specific dosing recommendations 1.

From the FDA Drug Label

For Intra-articular Or Soft Tissue Administration (See WARNINGS) DEPO-MEDROL is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. DEPO-MEDROL is an anti-inflammatory glucocorticoid for intramuscular, intra-articular, soft tissue or intralesional injection.

Yes, methylprednisolone (Medrol) can be used for intra-articular joint injections 2, 2. It is indicated for short-term administration to tide the patient over an acute episode or exacerbation in various conditions, including rheumatoid arthritis and synovitis of osteoarthritis.

From the Research

Intra-Articular Joint Injections with Methylprednisolone

• Methylprednisolone can be used for intra-articular joint injections, as evidenced by studies comparing its efficacy with other corticosteroids 3, 4.
• A study published in 2017 found that methylprednisolone acetate (MPA) and triamcinolone acetonide (TA) had similar efficacy in patients with chronic inflammatory arthritis, with no significant differences in time to relapse or change in pain and swelling scores 3.
• Another study from 2004 compared the effect of intra-articular injections of methylprednisolone with tropisetron, a 5-HT3 receptor antagonist, in patients with arthritides and activated osteoarthritis, and found that both treatments had similar effects on pain and inflammation 4.

Safety and Efficacy of Corticosteroid Injections

• The safety and efficacy of corticosteroid injections, including methylprednisolone, have been evaluated in various guidelines and studies 5, 6, 7.
• A practice guideline published in 2025 recommends the use of corticosteroid injections for managing joint chronic pain in adults, with specific recommendations on dosage and administration 5.
• A survey of sports medicine physicians found that methylprednisolone is commonly used for large joint and bursa injections, often in combination with local anesthetics such as lidocaine 7.

Dosage and Administration

• The commonly used dose for hip intra-articular corticosteroid injections is 40 mg triamcinolone or methylprednisolone 5.
• A study found that 40 mg of triamcinolone is as effective as 80 mg for knee intra-articular corticosteroid injections 5.
• Sports medicine physicians often use 21-40 mg of methylprednisolone for large joint and bursa injections, with some using higher doses 7.