Joint Injection / Aspiration

The Rheumatology Services provides relatively painless and comfortable procedures on an outpatient basis, being completed in just a few minutes. A joint injection (intra-articular injection) or soft tissue injection is a procedure used in the treatment of inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis and osteoarthritis (OA). A hypodermic needle is used to inject a drug ( e.g. corticosteroids) into the affected joint along with a local anesthetic agent such as xylocaine. Usually, a single dose of corticosteroids is given into a joint.

Hyaluronic acid or Hyaluronan, because of its high viscosity, is sometimes used as an intra-articular injection for patients with OA. Hyaluronan is used to relieve knee pain due to OA. It may be considered for patients who do not get enough relief from simple painkillers such as paracetamol, NSAIDs, or from exercise and physiotherapy. The recommended dosage was one 2-ml injection once a week for three weeks (three injections per knee), but now Synvisc-One is given as a single 6 ml injection into the joint.

Other preparations are Euflexxa- one dose per week (3 total doses), Hyalgan- one dose per week (3 to 5 total doses), Orthovisc- one dose per week (3 to 4 total doses), and Supartz- one dose per week (5 total doses). The pain relief can last up to six months. Some people who have arthritis in both knees choose to have both done at the same time.

Hyaluronan is generally well tolerated. However, it may not work for everyone. Before trying Hyaluronan, tell Dr. Sukhbir Uppal if you are allergic to products from birds—such as feathers, eggs or poultry. Hyaluronan has not been tested in children, pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child.

After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At this point, either joint fluid can be obtained and sent for appropriate laboratory testing or medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon to treat tendonitis and bursitis, respectively.

Joint aspiration is usually done as a diagnostic or therapeutic procedure. Fluid obtained from a joint aspiration can be sent for laboratory analysis, which may include a cell count (the number of white or red blood cells), crystal analysis (so as to confirm the presence of gout or pseudogout), and/or culture (to determine if an infection is present inside the joint). Drainage of a large joint effusion can provide pain relief and improved mobility.

Injection of a drug into the joint may yield complete or short-term relief of symptoms. Joint injections are given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and occasionally osteoarthritis. Corticosteroids are frequently used for this procedure, as they are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation within the joint space. Hyaluronic acid is a viscous lubricating substance that may relieve the symptoms of osteoarthritis of the knee. It is not used for osteoarthritis of any other joint.

Most joint injections utilize anti-inflammatory medications called corticosteroids (such as methylprednisolone acetate “Depomedrol” or triamcinolone hexacetonide “Kenalog”). These medications act locally and have few systemic side effects (such as a fever, rash, or a disturbance of an internal organ). In degenerative joint diseases such as osteoarthritis, a joint lubricant such as hyaluronic acid (described above) may be used with aim of relieving pain.

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, thumb and small joints of the hands and feet. Hip joint injection may require the aid of an X-Ray called fluoroscopy for guidance.

Common side effects include allergic reactions (to the medicines injected into joints, to tape or the betadine used to clean the skin, etc). Infections are extremely rare complications of joint injections. Another uncommon complication is “post-injection flare” – joint swelling and pain several hours after the corticosteroid injection – which occurs in approximately one out of 50 patients and usually subsides within several days. It is not known if joint damage may be related to frequent corticosteroid injections. Generally, repeated (> 4 per year) and numerous injections into the same joint/site should be discouraged. Other complications, though infrequent, include depigmentation (a whitening of the skin), local fat atrophy (thinning of the skin) at the injection site and rupture of a tendon located in the path of the injection.

The most common reasons for not performing a joint injection are the presence of an infection in or around a joint and if someone has a serious allergy to one or more of the medications that are injected into a joint.