A joint injection is when a steroid medication is injected by a needle directly into the joint that is causing you pain, stiffness and swelling.
It is part of a treatment plan for arthritis.
Fluid can also be removed before the steroid is injected (called an aspiration). This can then be analysed in the laboratory. Occasionally, as a result we will not proceed with the steroid injection until we have a diagnosis of this fluid.
If there is a lot of fluid present (an effusion) then the joint can be drained for comfort and help with your function and range of motion in that joint.
Joint injections may be given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and, osteoarthritis.
How is a joint injection given?
Joint injections are given in the clinic environment, either with your doctor or with one of the nurse specialists.
Joint injections can be performed in the clinic, in a procedure room, or sometimes in an operating room if many joints will be injected.
It is important for the patient to stay as still as possible during the procedure.
The skin around the joint being injected will be carefully cleaned to remove bacteria over the skin. A needle is then injected into the joint space. A small amount of local anaesthetic may be used which might sting a little at first but will help numb the area.
It may be that fluid needs to be removed; an empty syringe will be attached to pull fluid out. The same needle stays in throughout the whole procedure. After fluid is removed (if required), a small syringe containing the steroid is attached and slowly injected into the joint.
The needle is removed, and pressure is held to prevent bleeding or leaking of the steroid.
What are the risks?
Complications of joint injections are rare but include:
Infection to the area:
This risk is very low (<1 in 10,000) but needs to be mentioned. Every care is taken with using sterile equipment and cleaning of the area to reduce this risk. This is why if there is a risk that the joint is already infection we will wait for the laboratory results from the aspirate before proceeding. If you develop a fever, pain that is not resolving or heat from the joint you must seek medical help.
Some people find that they have a 48hr hour period of increased pain and swelling before this subsides, if allowed you may manage this with an NSAID.
Lack of effect:
Some people they find that they do not gain much benefit from a steroid injection.
What are the benefits?
It should help relieve pain and swelling in the joint for 2 months or longer.
The steroid only works in the joint it is injected into rather than affecting the whole body, which reduces the risk of side effects associated with steroids.
It can be used as a bridge when waiting for other medications to start working (for example if you have been started on a DMARD)
How often can I have a joint injection?
Frequent steroid injections can cause damage to your bones and put you at risk of infections. Steroid injections may not be given if you have a current infection and may only be given once you have recovered from this to prevent risk of worsening your infection.
You should not have more than 4 steroid injections in a year.
In some circumstances, you may have more than 4 steroid joint injections in one year ONLY following advice from your Rheumatologist.
Questions that your nurse may ask you on day of your appointment:
Have you had a joint steroid injection in the past?
This is to ascertain that you know what to expect with the procedure or if there was any complications in the past injections that we may need to know. The procedure will be explained and consent obtained prior to the procedure.
Do you have any allergies?
To know if you have had any history of drug allergies
Do you have a current infection or taking an antibiotic?
the procedure may be deferred until you are clear from infection
Are you taking any blood thinning tablets e.g. warfarin?
your INR level must be ≤2.5 as higher than this will put you at risk of bleeding
Are you diabetic?
Steroids can increase your blood sugar level
In most cases the procedure is well tolerated.
You are advised to rest the injected joint for at least 24-48 hours after the procedure to prevent further trauma to the injected joint and prevent risk of infection.
You may take simple painkillers like paracetamol should the injection site become painful.
Seek medical help should there be signs of infection ( such as feeling unwell, fever, redness and warmth to touch of the injected joint) after you have had your injection.
How can I arrange a joint injection if I feel I need one?
You can contact the Rheumatology Telephone Advice Line or your GP can refer you to the clinic. In order to be considered for a joint injection patients should usually have been seen by their Rheumatologist or GP within the past year.