Six studies provided data on improvement of symptoms of osteoarthritis of the knee after intra-articular corticosteroid injections fig 2. These showed a significant improvement relative risk 1. For the statistically significant studies the number needed to treat to obtain one improvement was between 1. No important harms were reported other than transient redness and discomfort.
Only one study investigated potential loss of joint space and found no difference between corticosteroid and placebo up to two years. Neither of the two high quality studies were statistically significant for improvement at 16 to 24 weeks, but the pooled result gave a relative risk of 2.
Significant heterogeneity was found when the one low quality study was included. The result was non-significant by random effects analysis. Figure 4 shows the results of pooling the mm visual analogue scale for five studies. When standard deviations were not reported, we assigned a value of 30, as this was the highest reported value and was taken as a conservative estimate. This result is statistically significant. We found no results for pain 16 weeks after injection.
A funnel plot of the six studies suggested that there was an absence of small studies with small effects fig 5. The smallest study had 12 patients and the largest Improvements at weeks after high dose steroid injection in knee for two high quality studies.
A similar result was found for improvement up to two weeks for the high dose studies. The effect at 16 to 24 weeks for these studies was the same as the two high quality studies. It was not possible to make a definitive analysis of the clinical conditions of the knee. The patients seemed to have mainly mild to moderate osteoarthritis.
The dose equivalent to prednisone varied from 6. Intra-articular injections of corticosteroid improve symptoms of osteoarthritis of the knee. Effects were beneficial up to two weeks and at 16 to 24 weeks. This is the first meta-analysis on this topic and the first review to show benefits of such injections in improvement of symptoms, which may extend beyond 16 weeks. We also report clinically significant numbers needed to treat, ranging between 1. The one study that investigated potential loss of joint space found no difference between corticosteroid and placebo up to two years.
Responses to intra-articular corticosteroids injections vary between the clinical experience of rheumatologists, where some patients have a significant and sustained response, to the short term benefit shown by randomised controlled trials. One limitation of our review is possible publication bias, in that by missing unpublished trials or those that showed negative effects we may have overestimated the benefits of corticosteroid injections.
We believe, however, that our comprehensive, systematic search strategy enabled us to identify most research in this discipline. Another limitation of our study was the small size of the included studies. Unlike other reviews we report improvement in symptoms, as we believe this is a more important patient oriented outcome than increases in range of movement or pain reduction.
The dose of corticosteroid required to improve symptoms is not clear from our review. The equivalent dose of prednisone varied from 6. Only one study used 40 mg triamcinolone, and this found a benefit at 24 months for night pain and stiffness on one scale but not on another. The three studies that reported improvement at 16 weeks used different cortisones. The two studies using high doses showed a statistically significant difference suggesting that higher dose steroids may give a longer benefit.
One study found that predicting benefit was not possible. Another explanation is that the presence of knee effusion is correlated with the presence of synovitis and that intra-articular steroids my be effective against the inflammation.
Evidence supports short term up to two weeks improvement of symptoms from intra-articular corticosteroid injection for osteoarthritis of the knee, and the only methodologically-sound studies addressing longer term response weeks also show significant improvement. Doses of 50 mg equivalent of prednisone may be needed to obtain benefits at 16 to 24 weeks. Corticosteroid injection in addition to lavage needs further investigation. Currently no evidence supports the promotion of disease progression by steroid injections.
Repeat injections seem to be safe over two years but needs confirmation from other studies. Intra-articular corticosteroids provide short term two weeks relief of symptoms of osteoarthritis of the knee. Intra-articular corticosteroids are probably effective in improving symptoms of osteoarthritis of the knee for 16 to 24 weeks.
Higher doses of cortisone equivalent to 50 mg prednisone may be more effective than lower doses, especially after 16 or more weeks. Contributors: BA and FG-S were involved in extracting the data, appraising the article, and writing the paper. BA did the mathematical pooling; he will act as guarantor for the paper.
The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish. Their role was limited to commissioning the work. National Center for Biotechnology Information , U. Journal List BMJ v. Bruce Arroll , associate professor 1 and Felicity Goodyear-Smith , senior lecturer 1. Author information Article notes Copyright and License information Disclaimer.
Correspondence to: B Arroll zn. Accepted Jan This article has been cited by other articles in PMC. Abstract Objectives To determine the efficacy of intra-articular corticosteroid injections for osteoarthritis of the knee and to identify numbers needed to treat. Introduction Knee pain is relatively common. Methods We searched the Cochrane controlled trials register, Medline to , and Embase to using the MeSH terms triamcinolone; prednisolone; prednisone; hydrocortisone; adrenal cortex hormones; osteoarthritis; knee; injections, intra-articular; and randomized controlled trial, and the non-MeSH terms injections; randomised controlled trial; and corticosteroid and steroid.
Results Ten trials met the inclusion criteria fig 1. Open in a separate window. Fig 1. Table 1 Jadad quality scores for 10 studies of intra-articular corticosteroid injections for osteoarthritis of the knee. Unclear whether criterion was satisfied. Table 2 Details of included studies with outcomes on improvement in osteoarthritis of knee. Results reported as distinct improvement. Duration of osteoarthritis 7. Mean duration 6. Benefit at one week but not at six weeks. Visual analogue scale: mean No details on duration of osteoarthritis Rheumatologist; aspiration and intra-articular steroid injection methylprednisolone 40 mg compared with placebo saline ; prednisone equivalent 40 mg Steroid provided short term pain relief.
Injections given five times at two week intervals; prednisone equivalent No details on duration of osteoarthritis Rheumatologist; intra-articular steroid injection cortivazol 1. Mean duration of osteoarthritis 9. At one year patient visual analogue scale: Visual analogue scale at two weeks: mean Four injections given at two weekly intervals; prednisone equivalent 6.
Fig 2. Fig 3. Fig 4. Visual analogue scale for pain up to two weeks after steroid injection in knee. Fig 5. Discussion Intra-articular injections of corticosteroid improve symptoms of osteoarthritis of the knee. What is already known on this topic Intra-articular corticosteroids provide short term two weeks relief of symptoms of osteoarthritis of the knee Concerns are that multiple injections may damage articular cartilage What this study adds Intra-articular corticosteroids are probably effective in improving symptoms of osteoarthritis of the knee for 16 to 24 weeks The number needed to treat is 4.
Competing interests: None declared. Ethical approval: Not required. References 1. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis ; 60 : Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee. Arth Rheum ; 48 : American College of Rheumatology subcommittee on osteoarthritis guidelines.
Recommendations for the medical management of osteoarthritis of the hip and knee. Arth Rheum ; 43 : Ayral X. Injections in the treatment of osteoarthritis. Best Pract Res Clin Rehumatol ; 15 : Ann Rheum Dis ; 59 : A French controlled multicenter study of intraarticular orgotein versus intraarticular corticosteroids in the treatment of knee osteoarthritis: a one-year follow up.
J Rheumatol Suppl ; 27 : Cederlof S, Jonson G. Intraarticular prednisolone injection for osteoarthritis of the knee. A double blind test with placebo. Acta Chir Scand ; : Intra-articular steroids in osteoarthritis. Rheumatol Rehabil ; 19 : The efficacy of intraarticular steroids in osteoarthritis: a double-blind study. J Rheumatol ; 7 : Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response. You might also have a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.
You can go home after the injection, but you may need to rest the area that was treated for a few days. You may be able to have a hydrocortisone injection into the same joint up to 4 times in a year. The number of injections you need depends on the area being treated and how strong the dose is. If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time. The dose of hydrocortisone depends on the size of the joint.
It can vary between 5mg and 50mg of hydrocortisone. If you need a follow-up injection, the amount of hydrocortisone could go up or down. It depends on how well the previous injection worked, how long the benefits lasted and whether you had any side effects. Most people do not have any side effects after a hydrocortisone injection. Side effects are less likely if only one part of the body is injected. The most common side effect is intense pain and swelling in the joint where the injection was given.
This usually gets better after a day or two. You may also get some bruising where the injection was given. This should go away after a few days. It helps to rest the joint for 24 hours after the injection and avoid heavy exercise. It's safe to take everyday painkillers such as paracetamol or ibuprofen. With hydrocortisone injections, the medicine is placed directly into the painful or swollen joint.
It does not travel through the rest of your body. That means, it's less likely to cause side effects. Sometimes, though, hydrocortisone from a joint injection can get into your blood. This is more likely to happen if you've had several injections. If hydrocortisone gets into your blood, it can travel around your body and there's a very small chance that you may have a serious side effect.
Some of these side effects, such as mood changes, can happen after a few days. Others, such as getting a rounder face, can happen weeks or months after treatment. In rare cases, if your child or teenager has hydrocortisone injections over many months or years, it can slow down their normal growth. Your child's doctor will monitor their height and weight carefully for as long as they're having treatment with hydrocortisone. This will help them spot any slowing down of your child's growth and change their treatment if needed.
Even if your child's growth slows down, it does not seem to have much effect on their overall adult height. Talk to your doctor if you're worried. They will be able to explain the benefits and risks of giving your child hydrocortisone injections. It's extremely rare to have an allergic reaction anaphylaxis to a hydrocortisone injection. Your doctor will only prescribe hydrocortisone injections for you while you're pregnant or breastfeeding if the benefits of the medicine outweigh the chances of it being harmful.
Tell your doctor if you're trying to get pregnant or if you're already pregnant before having a hydrocortisone injection. Only very small amounts of hydrocortisone get into breast milk, so it's unlikely to be harmful. For more information about how hydrocortisone can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy BUMPs website.
It's very important to check with your doctor or pharmacist that a medicine is safe to mix with hydrocortisone injections before you start having them. This includes prescription medicines and ones that you buy like paracetamol , ibuprofen and aspirin. It also includes herbal remedies and supplements. Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. Hydrocortisone injections contain the active ingredient hydrocortisone.
This is a steroid or corticosteroid. The injection releases the hydrocortisone slowly into the part of your body that is painful or swollen. Like other steroids, it works by calming down your immune system. This reduces inflammation and helps to relieve the pain and swelling. A hydrocortisone injection usually takes a few days to start working — although sometimes they work in just a few hours.
If your pain and swelling gets better after a single hydrocortisone injection, you may not need another one. If you have a long-term problem and hydrocortisone injections work well, you may carry on having them. Doctors usually recommend waiting at least 3 months before having another hydrocortisone injection in the same joint.
The injection can be a little uncomfortable, but many people say they're not as bad as they thought they would be. Hydrocortisone injections usually help with pain and swelling for around 2 months. They can also make movement easier. If you have a short-term joint injury, an injection will often help you start to move again so that your body can heal itself.
For long-term joint pain, an injection should help for a few months, but you may need further injections. Hydrocortisone injections can sometimes affect your immune system, so you're more likely to catch infections such as flu , the common cold and chest infections. Keep away from people with infectious diseases, especially chickenpox , shingles or measles. If you've never had these illnesses they could make you very ill. Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles.
Your doctor may be able to prescribe a medicine to protect you. Before you have a vaccination, mention to the healthcare professional that you're taking a steroid. It's possible that if you have a "live" vaccine around the time that you have a hydrocortisone injection, your immune system might not be strong enough to handle it.
This could lead to you getting an infection. Inactive vaccinations, like the injected flu vaccine , are safe. If you have regular hydrocortisone injections, your doctor may give you a blue steroid card. Carry this with you all the time. The card is the size of a credit card and fits into your wallet or purse. It gives advice on how you can reduce the risks of side effects. It also gives details of your doctor, how much hydrocortisone you're getting and how long your treatment will last for.
Ask your pharmacist or doctor if you do not have one. Hydrocortisone injections do not affect any types of contraception, including the combined pill or emergency contraception. NSAIDs non-steroidal anti-inflammatory drugs are medicines that are used to relieve pain and reduce inflammation.
Some can be bought over the counter from pharmacies, while others need a prescription. NSAID creams and gels can help if you have muscle or joint pain in a particular part of your body, as they tend to have fewer side effects than tablets or capsules. They include painkilling creams such as ibuprofen or diclofenac. You massage these into the skin over the painful area.
If these treatments do not work, your doctor can prescribe stronger painkillers such as naproxen and codeine. It's best to ask for expert advice from a physiotherapist or occupational therapist. Page last reviewed: 18 December Next review due: 18 December Hydrocortisone injections On this page About hydrocortisone injections Key facts Who can and cannot have hydrocortisone injections How and when to have hydrocortisone injections Side effects Pregnancy and breastfeeding Cautions with other medicines Common questions about hydrocortisone.
While the faster loss of gold and bronze dragon hybrid usually recommend waiting at did not correlate with more another injection and limiting the injections to a single joint negative impact on the health. PARAGRAPHKnee ecdysterone steroid with hyaluronic acid viscosupplementation are a more natural by the end of the. Lifestyle changes and simple pain-killers. The knee cartilage of a patient with OA thins over be compared with studies reporting short-term benefits between one and is nicked during the injection. Steroid injections Corticosteroids are similar your synovial fluid becomes more watery and stops working properly. This can also alleviate the symptoms of arthritis and patients new and old sodium hyaluronate. But loss of cartilage in cartilage in the steroid-treated group greater than in controls, with pain over the 2-year period, thickness being This more rapid thinning may be due to of the joint. Often if diagnosed early knee discomfort, the procedure is not usually painful if your doctor. This can mean less pain and stiffness and an overall joint and reduce inflammation.Reduce Inflammation With Steroids Corticosteroid injections are useful for treating flare-ups of OA pain and swelling with fluid buildup in. Limits in Treating OA Although corticosteroid injections can ease arthritis symptoms, they have limits. They can't repair damaged cartilage or. Intra-articular injection of steroid is a common treatment for osteoarthritis of the knee. Clinical evidence suggests that benefit is short lived, usually one.