INFO - Local corticosteroid injection

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Arthritis Research Campaign

2004

" The Use and Abuse of Steroids in Rheumatology " :

Excerpt:

LOCAL CORTICOSTEROID INJECTION

Local steroid injection is a relatively simple, safe and effective treatment

used in patients with inflammatory arthropathies and soft tissue rheumatism.

Benefit has been shown in conditions such as tennis elbow, de Quervain's

tenosynovitis and digital flexor tenosynovitis ('trigger finger').

Intra-articular injection may also be useful for settling one or two

particularly troublesome joints in patients with an inflammatory arthritis.

Intra-articular steroids often relieve acute exacerbations in osteoarthritic

knees when an inflammatory component is suggested by a significant effusion.

Occasional benefit may be seen in osteoarthritis of the acromioclavicular

joint and small joints of the hand, lumbar facet arthropathy and fibrositic

trigger points. Epidural injection can be helpful in treatment of sciatica,

but use of the epidural route is unlicensed.

Injections should be performed using an aseptic or 'no-touch' technique and

the patient advised to rest the injected area for 24 hours. There is no

clear consensus about the upper limit of frequency of repeated

intra-articular injections, but it is often recommended that no more than 3

injections per year are given into weight-bearing joints. Contra-indications

to injection include articular infection (or suspicion of infection),

periarticular infection or ulceration and bacteraemia. Great care must be

exercised in the presence of chronic foci of infection and in patients on

anticoagulants or with bleeding disorders. Local adverse reactions include

steroid flare, localized skin atrophy (which appears to be a greater problem

with triamcinolone than the shorter acting non-fluorinated steroid

preparations), corticosteroid arthropathy and tendon rupture. Iatrogenic

infectious arthritis follows 1 in 14,000-50,000 injections. Some systemic

effects may still occur following intra-articular injection, particularly

when multiple joints are injected. These effects may be beneficial, such as

reduced pain and swelling at joints distant from the injection site, or

undesirable such as facial flushing and suppression of the HPA axis.

http://www.arc.org.uk/about_arth/med_reports/series3/pp/6338/6338.htm

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Mayo Clinic in Rochester

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s Hopkins Medicine

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