Intraarticular injections

Corticosteroid injections

These should be given as adjunctive therapy. Effusions, when present, should be aspirated before injections are administered. Periarticular injections of hydrocortisone are sometimes used to relieve painful bursitis associated with OA,111 whereas injections of methylprednisolone or triamcinolone into the knee joint may relieve the pain of OA for a few months.112

Intra-articular hyaluronan injections

There is a reduction in the size and concentration of hyaluronan (hyaluronic acid) molecules present in synovial fluid in joints affected by OA. As a result, the capacity to absorb shock and to lubricate articulating surfaces is reduced.113 A recent review concluded that injections of either preparation produce a small reduction in pain compared with placebo that may last several months.113 There is evidence to support the efficacy of hyaluronan in the management of knee OA, both for pain reduction and functional improvement. However, although pain relief may be obtained for several months, rather than for several weeks as with steroid, this benefit may be offset by its slower onset of action and by the requirement of a course of three to five weekly injections with the logistical and cost issues. There is minimal evidence for a role in disease modification.

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