From the Research
Oral steroids are not typically recommended as first-line treatment for prepatellar bursitis. Initial management should focus on conservative measures including rest, ice, compression, elevation (RICE), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg three times daily or naproxen 500mg twice daily for 7-10 days. If these measures fail to provide relief, aspiration of the bursa followed by a local corticosteroid injection (such as methylprednisolone 40mg or triamcinolone 20-40mg) directly into the bursa is preferred over oral steroids, as supported by the treatment algorithm developed in the study by 1.
Some key points to consider in the management of prepatellar bursitis include:
- Aspiration of the bursa and local corticosteroid injection are effective treatments for non-septic bursitis, with a study by 2 demonstrating the utility of intrabursal sclerotherapy in the management of recurrent non-septic prepatellar bursitis.
- Oral steroids like prednisone (typically 20-40mg daily for 5-7 days with a taper) may be considered in severe cases with significant inflammation when other treatments have failed, but they carry more systemic side effects including fluid retention, mood changes, elevated blood glucose, and increased infection risk.
- Antibiotics are necessary if the bursitis is infected, which presents with warmth, redness, and fever, as noted in the study by 1.
- Surgical treatment, such as bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases, as recommended in the study by 3 and 1.
The rationale for avoiding oral steroids as first-line therapy is that prepatellar bursitis is a localized inflammation, and targeted local treatments typically provide adequate relief with fewer systemic effects than oral corticosteroids, as supported by the study by 1 and 2.