What are joint injections?

From the Guidelines

Joint injections should be considered for acute exacerbation of knee pain in osteoarthritis, particularly when accompanied by effusion, as recommended by the EULAR guidelines 1. When considering joint injections, it's essential to evaluate the patient's condition and choose the most suitable treatment option. For instance,

• Intra-articular injection of long-acting glucocorticoids (GC) is indicated for acute exacerbation of knee pain, especially if accompanied by effusion, as stated in the EULAR recommendations 1.
• Hyaluronic acid injections may be used for knee osteoarthritis, but the size effect is relatively small, and suitable patients are not well defined 1.
• For gout, articular aspiration and injection of corticosteroids are recommended as first-line options for acute flares 1.
• In rheumatoid arthritis, intra-articular injections of GC may be considered in the presence of one or few residual active joints, as part of therapy adjustment 1.
• In hand osteoarthritis, intra-articular injections of glucocorticoids should not generally be used, but may be considered in patients with painful interphalangeal joints 1. The aim of joint injections is to improve patient-centered outcomes, such as reducing pain and inflammation, and the procedure should be performed under sterile conditions, often guided by ultrasound or fluoroscopy for accuracy.
• Contextual factors, including effective communication, patient expectations, and the setting in which the procedure takes place, can influence the outcome of joint injections 1.
• The magnitude of the placebo effect associated with this route of delivery should also be recognized 1.

From the FDA Drug Label

A single local injection of triamcinolone acetonide is frequently sufficient, but several injections may be needed for adequate relief of symptoms. Initial dose: 2. 5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entity being treated. For adults, doses up to 10 mg for smaller areas and up to 40 mg for larger areas have usually been sufficient. Single injections into several joints, up to a total of 80 mg, have been given.

• Joint injections of triamcinolone acetonide may be used for the treatment of various conditions, including rheumatoid arthritis, osteoarthritis, and other inflammatory joint diseases.
• The initial dose for joint injections is typically between 2.5 mg to 5 mg for smaller joints and 5 mg to 15 mg for larger joints.
• The maximum dose for joint injections is usually up to 10 mg for smaller areas and up to 40 mg for larger areas.
• In some cases, multiple joint injections may be given, with a total dose not exceeding 80 mg 2.

From the Research

Joints Injections Overview

• Joints injections are a common treatment for various joint-related conditions, including osteoarthritis and rheumatoid arthritis 3, 4, 5, 6, 7.
• Intra-articular corticosteroid injections are widely used to suppress local joint inflammation, providing rapid and pronounced relief, although the effect is usually temporary 3.

Types of Corticosteroids

• Different types of corticosteroids are used for joint injections, including methylprednisolone, triamcinolone, and triamcinolone hexacetonide 3, 5, 7.
• Triamcinolone hexacetonide has been found to be effective in providing clinical effect for a mean period of several months, but its use is recommended only by experienced clinicians due to the risk of local tissue necrosis 3.
• Methylprednisolone and triamcinolone seem to have similar efficacy, with minor differences seen in specific studies 5.

Dose and Volume

• The optimal dose and volume of corticosteroids for joint injections are still being researched, with varying doses and volumes used in different studies 5, 6, 7.
• A study found that 10 mg of triamcinolone acetonide was non-inferior to 40 mg in improving pain in patients with symptomatic knee osteoarthritis 6.
• Another study found that 20 mg of methylprednisolone or triamcinolone was commonly used for small joints, while 20 to 40 mg was used for intermediate joints 7.

Efficacy and Safety

• Joint injections have been found to be effective in reducing pain and improving function in patients with osteoarthritis and rheumatoid arthritis 3, 4, 5, 6, 7.
• However, the use of corticosteroids for joint injections also carries potential risks, including cartilage damage and progressive joint destruction, although the results of animal studies are ambiguous and most studies on humans suggest that the beneficial effects exceed the harmful effects when used appropriately 3.
• Strict aseptic technique is essential to avoid iatrogenic septic arthritis, and the indications and contraindications should always be considered before intra-articular corticosteroid injections 3.