Would steroids help with a swollen knee?

Steroids for Swollen Knee

Yes, intra-articular corticosteroid injections are strongly recommended for short-term pain relief in patients with a swollen knee, particularly when associated with osteoarthritis and effusion. 1

Efficacy and Timing of Steroid Injections

Intra-articular corticosteroid injections provide significant benefits for knee swelling:

• Provide clinically important and statistically significant pain relief starting at 1 week after injection 1
• Effects may last up to 6 weeks, with some studies showing improvement at 4 and 24 weeks 1
• More effective than placebo for pain reduction and patient global assessment at one week post-injection 2
• Onset of effect is rapid but generally less durable than hyaluronic acid products 2

Indications for Steroid Injections

Corticosteroid injections are particularly beneficial in these scenarios:

• Acute pain flares with effusion 1
• When oral medications like NSAIDs or acetaminophen have failed to provide adequate relief 3
• As part of a comprehensive treatment approach for osteoarthritis of the knee 3

Administration Considerations

• For knee joints, ultrasound guidance is helpful but not required (unlike hip injections where it's strongly recommended) 3
• Triamcinolone hexacetonide may be superior to betamethasone for longer-lasting pain reduction 2
• Methylprednisolone has shown improvement at both 4 and 24 weeks in some patients 1

Limitations and Precautions

• Limit frequency to no more than 3-4 injections per year 1
• Benefits are typically short-term (up to 6 weeks) rather than long-term 2
• Recent evidence suggests corticosteroid injections may be associated with an increased risk of requiring knee arthroplasty in patients with or at risk of developing symptomatic OA 4
• Avoid injections within 3 months of planned joint replacement surgery 1
• Long-term use may negatively impact bone health, joint structure, and meniscal thickness 1

Alternative and Complementary Approaches

If steroids aren't appropriate or after steroid treatment, consider:

• Oral NSAIDs (strongly recommended for knee OA) 3
• Topical NSAIDs (useful alternative for those unable to tolerate oral NSAIDs) 1
• Hyaluronic acid injections (may provide longer-lasting relief than corticosteroids, particularly for early radiographic stage OA) 1
• Conservative measures: rest, ice application, compression bandage, and elevation 1
• Quadriceps strengthening exercises and regular mobility exercises 1
• Weight reduction for overweight patients 1

Treatment Algorithm

1. First-line: Conservative management with rest, ice, compression, elevation, and oral NSAIDs
2. If inadequate response or significant effusion: Consider intra-articular corticosteroid injection
3. For recurring symptoms: Limit to 3-4 injections per year; consider hyaluronic acid for longer-term relief
4. For persistent symptoms despite injections: Consider referral to specialist for additional management options

Intra-articular corticosteroid injections remain an important tool in managing knee swelling, particularly in the context of osteoarthritis, providing effective short-term relief while other longer-term strategies are implemented.