Intra-Articular Injections to Treat Joint Disorders

Benefits, Risks, and Limitations of Joint Injections

An intra-articular injection is a type of shot that's placed directly into a joint to relieve pain. Corticosteroids (steroids), local anesthetics, hyaluronic acid, and Botox are the most common substances injected into joints for this treatment.

Your doctor might discuss an intra-articular injection with you if your pain has not improved with conservative treatments, such as pain relievers, oral anti-inflammatory drugs, and physical therapy.

A doctor inserting a knee injection
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Types of Intra-Articular Injections

Besides treating pain, intra-articular injections can have other purposes, and different injected medications are used for different purposes. These injections may also be used to deliver chemotherapy drugs like Doxil (doxorubicin) directly into a joint affected by cancer. They may also be an effective means of eradicating a fungal infection in joints (also known as fungal arthritis).

When used for alleviating pain, different intra-articular therapies work in different ways:

  • Corticosteroids work by decreasing local inflammation. They do so by inhibiting the production of inflammatory cells that are naturally produced in response to an acute injury or chronic condition. Intra-articular treatments are most commonly used to treat osteoarthritis, acute gout, and rheumatoid arthritis of the knee. Intra-articular injection of corticosteroids for osteoarthritis of the hip and knee has earned a strong recommendation from the American College of Rheumatology, and a conditional recommendation for osteoarthritis of the hand. Long-term use of corticosteroids has been thought to progressively damage the joints, but this is controversial.
  • Hyaluronic acid is a naturally occurring substance found in synovial fluids that lubricate the joints. With osteoarthritis, this substance can rapidly break down and lead to worsening of the condition. Intra-articular injections have been used to increase lubrication, reduce pain, and improve the range of motion in a joint. However, clinical studies have been mixed on how effective these shots really are. The American College of Rheumatology now strongly recommends against injections of hyaluronic acid in hip osteoarthritis and conditionally recommends against their use in hands and knees affected by osteoarthritis.
  • Local anesthetics are sometimes delivered by intra-articular injections as a form of pain relief following arthroscopic surgery. But it is a practice that has come under scrutiny as evidence suggests that it may degrade chondrocytes (the only cells found in cartilage) in the joint.
  • Botox (botulinum neurotoxin A) injections may offer safe and effective pain relief in painful knee osteoarthritis, but more study is needed. Currently, the American College of Rheumatology conditionally recommends against Botox injections for osteoarthritis of the hip and knee.
  • Platelet-rich plasma (PRP) is derived from whole blood and contains platelets (a type of blood cell that is essential for clotting) and the liquid portion of blood known as plasma. Although intra-articular injections of PRP have been shown to reduce pain and improve physical function for some people, their effectiveness in osteoarthritis is controversial. The American College of Rheumatology strongly recommends against use of PRP in knee and hip osteoarthritis.

Treatment Considerations

The two main side effects associated with intra-articular injections are infections and local site reactions. Other side effects can occur in relation to the specific drugs or substances injected.

Intra-articular injections, by and large, should never be considered the sole means of treatment for osteoarthritis or other joint disorders. The effects of many of these drugs tend to wane over time, and the long-term impact, particularly of corticosteroids, on the joints themselves is controversial.

When used, corticosteroid shots should be scheduled no less than three months apart. The duration of relief can vary based on the type of steroid used.

Hyaluronic acid injections, by comparison, are generally administered as a series of shots scheduled over three to five weeks. They have been mainly used to buy time before knee replacement surgery in people who are unable to tolerate steroids and have not found relief from oral medications.

Botox, meanwhile, appears to have few side effects. Treatment effects can last as long as 12 weeks in some people and as short as four weeks in others.

The effectiveness of PRP is controversial, though there is some evidence that injections can help reduce pain and improve function. Treatment benefits have been reported to last anywhere from six to nine months.

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