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Whether you are looking to learn more about paediatric musculoskeletal problems, or are involved in the care of children, then PMM and PMM-Nursing will help you change your clinical practice for the better.

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.