Intraarticular steroid injection

What is intraarticular steroid injection?

It is an injection of some particulate steroid inside the synovial sac of the joint. But sometimes it is injected around the joint capsule also.

Which are the steroids that are injected?

The most common type of steroids that are used for intraarticular use are Methyl Prednisolone and Triamcinolone. Besides, depo preparation of Dexamethasone and Betamethasone is also available in some countries and used occasionally. Earlier, hydrocortisone or cortisone was used and nowadays these are not used.

Is it safe to use steroids inside the joints?

Depo-preparation of steroids doesn’t have many systemic effects when injected within joints and used within recommended doses. These depo-preparation are particulate steroids having prolonged effects for several weeks and that’s why they should not be repeated too often particularly within one month. Actually, repeated use of depot steroids can have cumulative effects and might have more side effects.

Thus, an intraarticular steroid is safe if used within recommended doses and if not repeated within one month.

What are the side effects of steroids?

Repeated use of steroids might have the following side effects:

• Moon face
• Weigt gain
• Hypertension
• Rise of blood sugar
• Increase of osteoporosis and osteoporotic fractures
• HPA exis suppression

How much steroid can be injected per dose?

The dose of steroids depends on the size of the joint. Thus, 5-40 mg of depo methylprednisolone or equivalent dose is used for small joints like facet joints, Sacroiliac joints, wrist joints, interphalangeal joints. Whereas, 20-80 mg of depo methylprednisolone or equivalent dose is used for large joints like knee joint, hip joint, shoulder joint, etc.

How can we minimize the doses of steroids?

Earlier, the injection of steroids was done in blind and landmark techniques. Thus, chances of inappropriate injection were a possibility. So, to minimize the possibility of inaccurate injection of steroids, larger doses and volumes were used so that some amount is installed inside the joint or at least around the joint.

Nowadays it is recommended to inject every intraarticular injection under some form of image guidance like C-arm or ultrasonography. So, with real-time image physician can see the needle tip inside the joint and inject it in the proper position.

Thus, with accurate placement of the needle, success can be assured and the total doses of steroids can be minimized.

What are the indications of an intraarticular steroid injection?

There are several indications of intraarticular steroid injections. These are:

• The most common indication is inflammation of joints in rheumatoid arthritis or spondyloarthritis. Commonly injected joints are wrist joints, interphalangeal joints, knee joints, hip joints, shoulder joints, ankle joints, facet joints, sacroiliac joints, etc.
• It is also indicated in degenerated arthropathies particularly when it is associated with joint effusion. However, regeneration therapies with platelet rich plasma, bone marrow aspirate, or adipose tissues are better choices for degenerated joints which is more commonly known as osteoarthritis.
• Sometimes it is used in crystal arthropathies like pseudogouts.

Can steroids be used outside joints also?

There are several indications of steroid use other than joints. The indications are:

• Carpal tunnel syndrome
• Tarsal tunnel syndrome
• Guyon’s canal entrapment
• Dequarvain’s diseas
• Tennis elbow
• Golfer’s elobow
• Different types of bursitis
• Plantar fasciitis

Sometimes depo methylprednisolone is used in systemic inflammatory conditions like rheumatoid arthritis flare-up, or in spondyloarthropathies.