Intra-articular steroid injections (IASI) can be an effective method for treating a variety of joint pain, including pain arising from osteoarthritis, a condition in which the cartilage that protects and cushions the joints breaks down over time.
With osteoarthritis, the bones formerly separated by the cartilage start rubbing directly against each other, resulting in damage to the bone and causing painful joints. Osteoarthritis is the most common form of arthritis and is a major cause of disability in older adults, most often affecting the spine, fingers, thumbs, hips, knees or toes.
Initially, this condition is typically treated with analgesics to control the pain, such as acetaminophen (also called Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammation, such as aspirin, ibuprofen and naproxen. However, if you have not experienced sufficient pain relief with these treatments, an injection of corticosteroid into the joint can sometimes be helpful for short-term pain relief and to increase mobility or movement in the joint.
Steroids or corticosteroids are medications designed to mimic natural hormones produced by the body that help reduce inflammation. Steroids may be used to reduce inflammation in tendons and ligaments in osteoarthritic joints. Corticosteroids may relieve pain caused by osteoarthritis for a short amount of time (weeks to months), or they may provide longer-lasting relief.
Intra-articular steroid injections can be an effective treatment option for some patients. The procedure is minimally invasive and uncomplicated. Before the actual steroid injection, the doctor will inject a local anesthetic in the treatment area to numb the skin. The doctor will then inject the steroid, typically using ultrasound or other guided X-ray for proper placement.
Following the intra-articular steroid injection, it is often helpful to ice the area, as the injection itself will cause some swelling. Immediately following the procedure you will likely feel quite comfortable because the area will be numb from the first injection of the local anesthetic.
Generally, the effects of the anesthetic will wear off about two hours following the procedure. At this time it’s normal to experience increased pain that may initially be worse than the pain experienced before the injection. This type of discomfort is called a post-injection flare and is the result of injection a steroid directly into the joint. The pain will subside in a day or two, and it’s recommended to treat the area with ice and over-the-counter analgesics during this time period.
The injection of any substance into a joint or tendon carries risks, although the chances of complications resulting from intra-articular steroid injections are low. Risks include damage to a tendon, ligament or nerve; bleeding into the tissue; and infection. It’s crucial that the injection site be closely monitored in the days following the injection for signs of redness, unusual swelling or infection.
Some patients have reported long-term relief of up to six months or longer from intra-articular steroid injections. In general, doctors limit steroid injections into a single joint area to three or four times per year, as there is some concern that repeated long-term use can cause damage to the joint and surrounding tissues.
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