What Is An Intraarticular Steroid Injection?
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Inflammation is one of the body’s primary reactions to injury. When an injury occurs, damaged cells and tissue debris are released. These released particles act as antigens that trigger a nonspecific immune response, which results in the proliferation of leukocytes. In addition to the proliferation of leukocytes, when an injury occurs blood flow to the area is increased and leukocytes, macrophages, and plasma proteins are transported to the area. The influx of macrophages, leukocytes, plasma proteins, and fluid results in redness, swelling, and pain, which are all classic signs of inflammation.
For patients who fail to respond to pain medications and non-steroidal anti-inflammatory drugs (NSAIDs), intraarticular steroid injections may be recommended for pain relief. Corticosteroids are similar to hormones that are naturally produced in the body that help to decrease inflammation. Intraarticular steroid injections help to decrease inflammation by reducing the number of mast cells, macrophages, lymphocytes, and inflammatory mediators in the body. Intraarticular steroid injections are used to help reduce pain and inflammation and increase range of motion of the affected joint.
How Is An Intraarticular Steroid Injection Performed?The skin around the affected area is sterilized with isopropyl alcohol (or iodine) prior to the injection. Ultrasound guidance can be used to ensure proper injection placement; however, the use of standard anatomic landmarks results in proper needle placement for most patients who have uncomplicated cases. The physician then selects the appropriate sized needle for the procedure. For larger joints, such as the knee or shoulder, a 1.5 inch, 21-gauge needle is usually used. For smaller joints a 0.5 inch, 23- or 25-gauge needle is usually used.
A corticosteroid, sometimes mixed with an anesthetic, is then injected into the affected joint. The medication should flow freely into the joint space; however, if there is resistance, rotating or repositioning of the needle may be needed to make sure that the needle is in the proper position. Once the medication is injected, the needle is removed and the injection site is covered with a bandage, if necessary. Intraarticular steroid injections typically take between five and 15 minutes to complete.
There are a variety of different steroids available for intraarticular steroid injections which all have differing effects and durations. Solubility is the main factor that determines the medication’s effectiveness and duration. The preferred steroids for intraarticular injections are insoluble because the effects of these steroids have a longer duration. Common corticosteroids that are used for intraarticular injections are prednisolone tebutate, hydrocortisone acetate, methylprednisolone acetate, triamcinolone, and triamcinolone hexacetonide.
The physician must first decide what steroid to use and then whether or not to add an anesthetic to the steroid for the intraarticular injection. This choice is based more on clinical preference then evidence. When an anesthetic is combined with the corticosteroid, patients often report quick pain relief following the injection, followed by a transient increase in pain as the anesthetic wears off and the corticosteroid begins to take effect. Long-term pain relief of symptoms is the result of the injected corticosteroid. Patients should be advised of the stages of pain relief prior to receiving an injection.
Other types of medications can also be injected directly into joints for pain relief, including a chemical called hyaluronan. Hyaluronan is made up of glucuronic acid and N-acetylglucosimine and is found in the synovial fluid, vitreous humor of the eyes, umbilical cord, and cartilage. Hyaluronan helps to lubricate the joints of the body and also provides shock absorption.
The U.S. Food and Drug Administration approved the use of intraarticular hyaluronan injections for the treatment of osteoarthritis symptoms in 1997. Furthermore, hyaluronan intraarticular injections are included in the American Academy of Orthopaedic Surgeons and the American College of Rheumatology treatment guidelines.
Intraarticular steroid injections are considered a safe and minimally invasive technique, however, as with any procedure there are potential complications that can occur. The most common complications include pain flare-ups, skin atrophy, fat atrophy, and facial flushing. Less common side effects include infection and tendon rupture. The risk of tendon rupture is the greatest with injections around the Achilles tendon and plantar fascia.
Conditions Related To Intraarticular Steroid InjectionsThe literature that is currently available supports the use of intraarticular steroid injections for the treatment of osteoarthritis joint pain and inflammation. Additionally, intraarticular steroid injections may be beneficial for patients suffering from other inflammatory joint disorders, including rheumatoid arthritis, gout, psoriatic arthritis, and tendinitis.
Osteoarthritis is a degenerative type of arthritis that results as the cartilage surrounding the joints of the body breaks down. Osteoarthritis can affect any joint in the body but it commonly affects the spine, hips, knees, shoulders, fingers, toes, and feet. Osteoarthritis is a very common condition; it is estimated that approximately 30% of individuals over the age of 50 have osteoarthritis, and over 80% of individuals over the age of 65 have signs and symptoms of the disease.
ConclusionIntraarticular injections are considered a safe and effective treatment option for patients suffering from painful and inflamed joints associated with a variety of conditions including osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis, and tendonitis. There are relatively few side effects associated with this procedure and for most patients the benefits of the medication outweigh the potential risks. Patients suffering from joint pain and inflammation should discuss their symptoms with their physician to determine whether an intraarticular steroid injection would provide pain relief for their condition.
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