This website used cookies to give you the best experience. By continuing to use this website you are consenting to cookies being used. You can delete and block cookies from within your browsers settings. For more information please refer to our privacy and cookie policy page.

Continue

Joint Injections

  • Intra-articular (Joint) corticosteroid injections are often used to control active arthritis in Juvenile Idiopathic Arthritis (JIA) -  during disease flares or as 'bridging agents' to allow time for other therapies such as methotrexate (MTX) to be effective. 
  • Informed consent / assent must be recorded in the patient case notes.
  • Joint injections are usually done as a day case and performed by individuals with appropriate training. In some centres nurses and physical therapists perform joint injections.
  • Analgesia is very important:
    • General anaesthetic for multiple joints or in younger children or to reach certain joints (e.g. hip, temporomandibular, subtalar joint).
    • Inhaled nitrous oxide (Entonox®) is useful in older children and for up to 4 larger joints.
    • Ethyl chloride topical spray is useful as topical skin anaesthesia. 
    • Sedation is not recommended — general anaesthetic is a much safer option.
  • Triamcinolone hexacetonide is the drug of choice with the dose determined by body size and which joints are to be injected.
  • Complications are uncommon with good technique - these include:
    • Transient increases in blood pressure although increase in appetite and weight gain are rare (and usually if multiple joints are injected).
    • Subcutaneous atrophy — most likely with joints with small intra-articular volume such as fingers, wrists, & subtalar joints.
    • Sepsis — very small risk (<1in10,000 with good aseptic technique).
  • Injected joints should be rested for 24h if possible but patients can be discharged home.
    • Vigorous exercise and contact sports are not recommended for at least 48 hours. 
    • Instructions to seek health care are important (e.g. fever, hot joint, increase in pain).
  • Nurses help explain the process and support patients and families on the day of the procedure.
  • Nurses often administer the inhaled nitrous oxide (Entonox®) and prepare the patient for theatre.

 

Why register?

Some parts of pmm which involve pictures or videos of children, can only be viewed by registered users. Registering also allows you to bookmark favourite pages and track your viewing.

find out more

pmm for you

Please help us ensure pmm is as useful to you as possible by completing this short survey

complete survey