What is regional musculoskeletal and joint injection therapy?
Injection Therapy is very straightforward – as if someone has osteoarthritis of the knee, for example, a needle is put into the knee joint and an injection of corticosteroids (or cortisone) is administered.
These cortisone shots and steroids soothe pain and reduce swelling. They are reducing inflammation from arthritis, whether it is osteoarthritis or rheumatoid arthritis, and are able to cause inflammation within that joint.
This allows for better functioning of the joint.
Injections of other substances, like viscosupplements, can also, similarly, be injected into a knee joint.
What joint areas can be treated with injection therapy?
Typically, a provider will make a decision about which joint requires an injection and what to inject.
Depending on access, and depending on if there are only one or two joints involved, you may get an injection.
If multiple joints are flaring, then it’s highly likely to be systemic, and instead, a more systemic - possibly oral medication - could be more appropriate.
What medications are used?
Other than steroids or cortisone, there are other drugs or, viscosupplementation, such as Hyalgan®, a hyaluronic acid-based derivative that can be used.
Hyalgan® injection is one of the brand names, as such there are also others like Euflexxa, and Gelsyn.
These medications are very thick, viscous substances that get injected into a knee joint and provide a “buffering” ability that does what cartilage does in a joint.
The end result is that these can reduce pain in patients with osteoarthritis.
The viscosupplementation is mainly approved for the knee and focused on this specific joint, and provides relief for it or treatment by accessing the joint through a needle or an injection.
How long do these injections last?
The viscosupplementation is done every six months.
The duration of the relief they provide depends on the severity of the patient’s osteoarthritis – sometimes, a patient can reach that six-month mark without symptoms.
Is there a difference between the different injections?
The steroid injections are different substances from viscosupplementation.
Also, in addition to joints, you can get a steroid injection into a bursa.
But there are patients who will get a Bursa Injection for a painful condition called Bursitis. The pain relief in these areas - after a cortisone injection - could last years!
The duration of relief from steroid injections can vary depending on severity of symptoms and patient risk factors.
However, it’s typically not done more often than every three to even six months.
Some patients respond to it and can last for a long time, and some people don't respond because of severe, bone-on-bone disease.
Is there a maximum number of injections allowed before looking for other treatment options?
Typically, if three steroid injections were done to a specific joint, then it’s probably time to start looking further into other options.
For example, one option is a unique steroid formulation which is a slow-release steroid.
These can be given once and repeated in six months, if needed.
This compound is formulated into the spheres that have steroid encapsulated into it, and once injected it is followed by a slow release of steroid from those spheres.
It's designed to release a certain amount of steroids over time or over six months. In cases where the other regular steroid didn't work, this special steroid can be tried.
Other times when steroids don't work at least after three injections were done to a knee, viscosupplementation may be recommended.
However, whereas the steroid injection can potentially go into different joints, the viscosupplementation and slow release steroid are only approved for the knee and not for every single joint.
Are there any side effects to either the viscosupplementation or the steroid injection?
Some patients do experience mild side effects after undergoing injection therapy.
Patients tend to have a little soreness after an injection or a feeling of fullness when a substance enters the joint.
This is a normal reaction when a patient gets a needle injected into their body, and there could be a bit of soreness in the area.
This can happen anytime a needle is put anywhere in the body and does quickly resolve.
Sometimes, patients also tend to have a feeling of fullness because of the fluid steroid or any of the viscous substances in their joints. This, too, resolves over time.
Do steroid injections deteriorate the cartilage between the joints?
Not when you limit it to, for example, no more than three times to a specific joint.
What if the injection does not work?
If these measures are not enough, you may be referred to an orthopedic specialist for further evaluation.
Although steroids are used for multiple diseases, viscosupplementation is only used for osteoarthritis in specific joints.
Depending on the disease, the surgeons would generally tell the patients of the next steps for their condition.
What to expect during your joint injection?
Although it’s minimally invasive, any similar or any invasive procedure always has a risk. For the injection, it would be expected to get a little soreness from the injected area.
There is also a possibility of little bleeding, although rare, similar to any injection procedure.
The corticosteroid can cause a mild transient elevation in their blood sugar, although it's a regional injection.
However this is much less and of shorter duration than systemic steroids which have a much higher likelihood of causing an elevation in blood sugar.
Overall there are few risks, these procedures have a good safety profile, and these side effects are typical for most injections that a patient may get.
Most importantly, all of these procedures are only done with informed consent.
At Southwest Florida Rheumatology, we require our patients to read about these potential risks and to talk to us to answer any questions they may have before getting any of the procedures.