Intra-articular corticosteroid injection arthritis

In common with other corticosteroids, triamcinolone is metabolised largely hepatically but also by the kidney and is excreted in urine. The main metabolic route is 6-beta-hydroxylation; no significant hydrolytic cleavage of the acetonide occurs. In view of the hepatic metabolism and renal excretion of triamcinolone acetonide, functional impairments of the liver or kidney may affect the pharmacokinetics of the drug. This may become clinically significant if large or frequent doses of intradermal or intra-articular triamcinolone acetonide are given.

Participants on corticosteroids were 11% less likely to experience adverse events, but confidence intervals included the null effect ( RR , 95% CI to , I 2 =0%). Participants on corticosteroids were 67% less likely to withdraw because of adverse events, but confidence intervals were wide and included the null effect ( RR , 95% CI to , I 2 =0%). Participants on corticosteroids were 27% less likely to experience any serious adverse event, but confidence intervals were wide and included the null effect ( RR , 95% CI to , I 2 =0%).

Intra-articular hyaluronic acid injections, also known as viscosupplementation, are widely used by orthopedic surgeons to treat osteoarthritis of the knee. There has been some debate about the effectiveness of viscosupplementation in earlier studies, most of which were manufacturer-sponsored studies. However, a Cochrane review of 76 clinical trials concluded that viscosupplementation was effective for treating knee osteoarthritis. 26 The treatment effect often lasted for up to four months and led to improvements in pain and function. 26   The biggest drawback of hyaluronic acid injections is the cost. Table 3 provides a cost comparison of intra-articular injections.

Most injections into the knee or a smaller joint, like that at the base of the thumb, are simple procedures that can be done in a doctor’s surgery. When performed by an experienced physician, the injection is only mildly uncomfortable.
First, the doctor cleans the skin in the area with an antiseptic. If the joint is puffy and filled with fluid, the doctor may insert a needle into the joint to withdraw the excess fluid and examine it. Removing the fluid rapidly relieves pain also because it reduces pressure in the joint and may speed-up healing. Next, the doctor uses a different needle to inject the corticosteroid into the joint.

Injecting a large joint, like the hip, is more complicated and may require imaging tests to help the doctor guide the needle into the joint. Experienced rheumatologists, orthopaedic surgeons, anaesthetists, and radiologists may inject the facet joints of the lower spine.

Intra-articular corticosteroid injection arthritis

intra-articular corticosteroid injection arthritis

Most injections into the knee or a smaller joint, like that at the base of the thumb, are simple procedures that can be done in a doctor’s surgery. When performed by an experienced physician, the injection is only mildly uncomfortable.
First, the doctor cleans the skin in the area with an antiseptic. If the joint is puffy and filled with fluid, the doctor may insert a needle into the joint to withdraw the excess fluid and examine it. Removing the fluid rapidly relieves pain also because it reduces pressure in the joint and may speed-up healing. Next, the doctor uses a different needle to inject the corticosteroid into the joint.

Injecting a large joint, like the hip, is more complicated and may require imaging tests to help the doctor guide the needle into the joint. Experienced rheumatologists, orthopaedic surgeons, anaesthetists, and radiologists may inject the facet joints of the lower spine.

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