Intra-articular Steroid Injections of the Knee

9th June 2007 at 08:15 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article discusses the usage of intra-articular steroid injections for the knee.

Intra-articular Steroid Injections of the Knee

Introduction

Intra-articular steroid injections are a form of treatment for pain-relief from joint pain. Such steroids are used to decrease the inflammatory reaction associated with osteoarthritis and rheumatoid arthritis.

The intra-articular steroid therapy is one of the most common clinical procedures carried out by rheumatologists.

The basic intra-articular steroid injections are designed to provide 2 to 6 weeks of pain relief for patients with knee osteoarthritis. On the other hand, the higher-dose steroids with or without joint lavage can provide pain relief up to 24 weeks.

Research and Analysis

Research gives a varied evidence for the use of intra-articular steroid injections for relief from the pain of osteoarthritis of the knee.

In a study involving 312 patients, the pain was significantly reduced one week after the injection. However, the study also concluded that the beneficial effect of the injection lasted only for 3 to 4 weeks, beyond which it wasn't very effective.

Another study conducted amongst the affected patients showed that those who received the intra-articular steroid injections could bend their legs and straighten them much farther and better. These patients also reported less swelling around their knee.

A series of random studies also indicate a strong positive effect of the intra-articular steroid injections in the patients suffering from acute rheumatoid arthritis.

Other symptoms which showed considerable improvement with the use of intra-articular steroid injections for the knee included reduction in morning stiffness and ability to walk faster.

Application and Uses

Intra-articular steroid injections are frequently used as a part of the treatment plan for knee osteoarthritis. Steroid injections are often successfully used along with:

• Physical therapy
• Weight reduction programmes
• NSAIDs
• Topical and opioid analgesics
• Education

The intra-articular steroid injections are an effective remedy for decreasing pain and swelling quickly. In addition, patients may also opt for the intra-articular steroid injections to delay using steroid pills or arthritis drugs.

Types and Forms

There are various types of preparation of steroids that have a different duration of effect and action. The guiding principle which determines the effectiveness of each of these preparations is their solubility.

The insoluble preparations are known to have a longer duration of effect and are the most preferred. For the benefit of analysis, here we briefly list each one of the preparations of the intra-articular steroid injections.

1. a) Aristospan (Triamcinolone HEXACETANIDE) – These are the most soluble and preferred preparation for intra-articular injections. The duration of effect is usually 6 months.

2. b) Aristocort (Triamcinolone ACETONIDE) – Highly insoluble, this is the preparation normally preferred after the above. This particular preparation normally has a duration of 3 months.

3. c) Depo-medrol (Methylprednisolone acetate) – This is highly soluble and should only be used as a last resort. The duration of effect in this preparation is only 5 weeks.

The Procedure

Here we list the basic steps involved in using an intra-articular steroid injections for the knee.

1. Select the preparation
2. Inject the steroid into the joint
3. A local anaesthetic (lidocaine 1%) is injected at the same time to confirm whether the pain is relieved by the injection.
4. An iodinated contrast is injected to observe immediate distribution of the steroid and local anaesthetic and confirm which joints are being treated.

Specialists dealing with intra-articular steroid injections generally instruct their patients to maintain a simple diary of pain for at least a week's duration after the injection. The commonly recommended entry in the diary is pain vs. previously expected pain or same physical workload.

Complications

Though quite infrequent, but the intra-articular steroid injections also have certain risk factors involved. The most important amongst these are:

• Septic arthritis
• Loss of skin pigmentation (mainly in blacks)
• Joint degeneration

In some extreme cases, complications including joint destruction and tissue atrophy have also been reported.

Besides, the intra-articular steroid injections are not advised for:

• Diabetic patients
• Pregnant women
• Lactating mothers

Conclusion

The intra-articular steroid injections are being largely regarded as an effective treatment option to relieve the pain of knee osteoarthritis. These injections are known to improve pain, movement, stiffness and swelling.

However, such steroid therapy is being advocated as more of a short-term pain-relief option as against being a long-term solution.

Owing to the potential complications and the short-term benefit, it is important that the intra-articular steroid injections be performed only with the joint consent of the physician and the patient.

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