Mixing Steroids with Duralane (Hyaluronic Acid)
Triamcinolone acetonide is the steroid that can be mixed with Duralane (hyaluronic acid) in the same syringe for intra-articular injection.
Evidence for Triamcinolone Acetonide Combination
The combination of triamcinolone acetonide with hyaluronic acid has been studied across multiple joint conditions:
Knee osteoarthritis: A 1-year randomized trial demonstrated that 1 mL triamcinolone acetonide can be administered prior to hyaluronic acid injection, with the combined treatment providing superior early pain relief compared to hyaluronic acid alone 1.
Temporomandibular joint arthritis: A prospective study of 100 patients successfully used local infiltration of 40 mg triamcinolone acetonide combined with 20 mg hyaluronic acid, administered weekly for 4 weeks, showing statistically significant relief in pain (87/96 patients) and clicking sounds (81/88 patients) 2.
Adhesive capsulitis: A randomized, double-blind trial demonstrated that simultaneous intra-articular injection of corticosteroid with hyaluronic acid was more effective than either agent alone, with the combination group showing significantly higher improvement in Shoulder Pain and Disability Index scores (-58.4%) compared to hyaluronic acid alone (-14.4%) at one month 3.
Clinical Application
When combining these agents:
Dosing: Triamcinolone acetonide can be administered at 40 mg mixed with hyaluronic acid in the same injection 2, or 1 mL triamcinolone acetonide can be given prior to or with hyaluronic acid 1.
Timing advantage: The combination provides faster pain relief than hyaluronic acid alone, with the corticosteroid component offering immediate anti-inflammatory effects while hyaluronic acid provides longer-term viscosupplementation 3, 1.
Safety profile: Studies demonstrate this combination is well-tolerated with minimal side effects in most patients 2.
Important Caveats
Guideline recommendations: The American College of Rheumatology/Arthritis Foundation conditionally recommends against routine hyaluronic acid injections for knee osteoarthritis, as high-quality trials show effect sizes approaching zero compared to saline 4, 5.
First-line preference: Corticosteroid injections alone are strongly supported by 19 high-quality studies and are recommended as the evidence-based choice for intra-articular therapy in knee osteoarthritis by the American Academy of Orthopaedic Surgeons 4.
Consider combination only after: Non-pharmacologic therapies, topical/oral NSAIDs, and corticosteroid injections alone have failed 4, 5.