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Inventory of 7 types of joint cavity injection drugs, these drugs are controversial, beware!

 Last Update: 2021-11-12
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Conservative treatment of rheumatology diseases such as osteoarthritis (OA) and rheumatoid arthritis , such as analgesics, oral anti-inflammatory drugs and physical therapy, may consider intra-articular injections when pain does not improve
.
Corticosteroids (steroids), local anesthetics, hyaluronic acid, and botulinum are the most common substances injected into the joints for treatment

Conservative treatment of rheumatology diseases such as osteoarthritis (OA) and rheumatoid arthritis , such as analgesics, oral anti-inflammatory drugs, and physical therapy.

One, corticosteroids

Corticosteroids (glucocorticoids) work by reducing local inflammation

Corticosteroids (glucocorticoids) work by reducing local inflammation
.

Intra-articular injection of corticosteroids for hip and knee osteoarthritis has been strongly recommended by the European Academy of Clinical and Economics for Osteoporosis , Osteoarthritis and Musculoskeletal Diseases, the International Society for Osteoarthritis Research and the American Academy of Rheumatology, and Conditional recommendation for hand OA

The Chinese OA diagnosis and treatment guidelines (2021 edition) recommend that corticosteroid joint injections are suitable for acute exacerbations of knee joint pain, especially for patients with knee OA with effusion

Second, hyaluronic acid Hyaluronic acid naturally exists in the synovial fluid that lubricates joints .

Third, local anesthetics are sometimes injected into the joints in order to relieve pain after arthroscopic surgery

Fourth, botulinum toxin

Botox (botulinum neurotoxin A) injections can safely and effectively relieve knee osteoarthritis pain, but more research is needed

Five, platelet-rich plasma

Platelet-rich plasma (PRP ) is derived from whole blood and contains platelets and the liquid part of blood, called plasma

Six, stem cells stem cells

The American Academy of Rheumatology strongly discourages the use of stem cell injections in patients with knee and hip osteoarthritis
.
Because of the heterogeneity and lack of standardization of existing stem cell injection preparations
.

Seven, radioactive materials

Radiation synovectomy (the RSO) is via the card useful for topical important tool for chronic inflammatory joint disease treatment
.
As an alternative to surgical synovectomy, local application of radioactive agents is used to try to reduce slip damage
.
Basically, RSO is suitable for the local treatment of almost all types of chronic synovitis, and the indications include rheumatoid arthritis, OA and seronegative spondyloarthropathy and so on
.

Radiation synovectomy (the RSO) is via the card by card useful in the topical treatment of chronic inflammatory arthropathy important tool useful for topical important tool for chronic inflammatory joint disease treatment
.
As an alternative to surgical synovectomy, local application of radioactive agents is used to try to reduce slip damage
.
Basically, RSO is suitable for the local treatment of almost all types of chronic synovitis, and the indications include rheumatoid arthritis, OA and seronegative spondyloarthropathy and so on
.

Eight, treatment precautions

The two main side effects associated with intra-articular injections are infection and local reactions
.
Other side effects may be related to the specific drugs or substances injected
.
In general, intra-articular injections should not be regarded as the only way to treat osteoarthritis or other joint diseases
.
The effects of many of these drugs tend to diminish over time, and the long-term effects of drugs (especially corticosteroids) on the joints themselves are controversial
.

The two main side effects associated with intra-articular injections are infections and local reactions.
The main side effects are infections and local reactions
.
Other side effects may be related to the specific drugs or substances injected
.
In general, intra-articular injections should not be regarded as the only way to treat osteoarthritis or other joint diseases
.
The effects of many of these drugs tend to diminish over time, and the long-term effects of drugs (especially corticosteroids) on the joints themselves are controversial
.

For intra-articular use, the interval between corticosteroid injections should be no less than three months, and no more than 2 to 3 times a year
.
The duration of pain relief may vary depending on the type of steroid used
.

For intra-articular use, the interval between corticosteroid injections should be no less than three months, and no more than 2 to 3 times a year
.
The interval between corticosteroid injections should be no less than three months, and no more than 2 to 3 times a year
.
The duration of pain relief may vary depending on the type of steroid used
.

Hyaluronic acid injections are usually given in a series of injections within three to five weeks , mainly for patients who cannot tolerate steroids and cannot be relieved by oral medications before knee replacement surgery
.

Hyaluronic acid injection is usually a series of injections in three to five weeks, usually a series of injections in three to five weeks , mainly for patients who cannot tolerate steroids and cannot get relief from oral medications before knee replacement surgery
.

No side effects have been found for intra-articular injection of botulinum toxin
.
The treatment effect can last for 4-12 weeks and varies from person to person
.

The effectiveness of PRP is controversial, although there is some evidence that injections can help reduce pain and improve function
.
According to reports, the treatment effect can last for 6 to 9 months
.

The precautions raised by the European Union against Rheumatism (EULAR) for the specific implementation of joint injections include:

1.
shall during pregnancy must be considered whether the compound is safe for mother and child articular injection, intraarticular injection of the radiopharmaceutical during pregnancy is a contraindication
.

1.
1.
should during pregnancy during pregnancy when injected joints must consider whether the compound is safe for mother and child, radiopharmaceutical articular injections during pregnancy is a contraindication
.

2.
Aseptic technique should always be used
.

2.
2.
Aseptic technique should always be used
.
Use aseptic technique
.

3.
Local anesthetics should be provided to patients, explaining the pros and cons
.
Several randomized controlled trials of knee and hip OA have shown that glucocorticoids and local anesthetics can improve pain for a longer time than local anesthetics alone
.

3.
3.
Patients should be provided with local anesthetics, explaining the pros and cons
.
Several randomized controlled trials of knee and hip OA have shown that glucocorticoids and local anesthetics can improve pain for a longer time than local anesthetics alone
.

4.
Diabetes patients, especially those who are poorly controlled, should be informed of the risk of transient increase in blood sugar after joint injection of steroids, and it is recommended to monitor blood sugar levels, especially for the first to three days after joint injection
.

4.
4.
diabetic patients, especially those with poorly controlled, should be informed of the risk of post-articular injection of steroid transient elevated blood sugar, and recommended monitoring blood sugar levels, especially after the first three days articular injection
.
diabetes

5.
Joint treatment is not a contraindication for people who have clotting/bleeding disorders or taking antithrombotic drugs, unless the risk of bleeding is high
.

5.
5.
Joint treatment is not a contraindication for people with coagulation/bleeding disorders or those taking antithrombotic drugs, unless the risk of bleeding is high
.
thrombus

6.
Joint injection can be done at least 3 months before the joint replacement surgery , or after the joint replacement after consultation with the surgical team
.

6.
6.
articular injection may in joint replacement surgery before at least three months at least 3 months , can also be carried out in consultation with the team after surgery after joint replacement
.

7.
Avoid overuse of the injected joint within 24 hours after the joint injection ; however, it is not encouraged to stay still
.
Leakage of radioisotope radiation to extrasynovial tissue can be minimized by splinting within 48 hours
.

7.
7.
Avoid excessive use of the injected joint within 24 hours after the joint injection.
Avoid excessive use of the injected joint within 24 hours after the injection ; however, it is not encouraged to stay still
.
Leakage of radioisotope radiation to extrasynovial tissue can be minimized by splinting within 48 hours
.

8.
Before reinjecting the joint , the benefits of the previous injection and other individualized factors (for example, treatment options, compounds used, systemic treatment and comorbidities, etc.
) should be considered .

8.
8.
should again before the injection of the joint consideration of the benefits and other individual factors of previous injections consider the benefits and other individual factors of previous injections (e.
g.
, treatment options, the compound used, the treatment of systemic complications and the like)
.

Although intra-articular treatments have been tested for different doses, frequencies, and intervals, they are rarely designed to assess the long-term effects of repeated injections
.
At present, most of the indications for joint injections do not have clear evidence-based recommendations on the number of times from the perspective of risk and benefit
.
Although there is no research evidence, the generally accepted rule is to inject no more than 3-4 glucocorticoids per year in the same joint
.

references:

[1].
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, et al.
2019 American College oRheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.
Arthritis Care Res (Hoboken) .
2020 Feb;72(2):149-162.

[2].
Joint Surgery Group of Orthopedics Branch of Chinese Medical Association, Osteoarthritis Group of Orthopedics Branch of Chinese Medical Doctor Association, National Clinical Research Center for Geriatric Diseases (Xiangya Hospital), etc.
Guidelines for Diagnosis and Treatment of Osteoarthritis in China (2021 Annual edition) [J].
Chinese Journal of Orthopaedics, 2021, 41(18): 1291-1314.

[3].
Arden NK, Perry TA, Bannuru RR, Bruyère O, Cooper C, Haugen IK, Hochberg MC, McAlindon TE, Mobasheri A, Reginster JY.
Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines.
Nat Rev Rheumatol.
2021 Jan;17(1):59-66.

[4].
Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC.
Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Am J Sports Med.
2021 Jan;49(1):249-260.

[5].
Arthritis Foundation.
Hyaluronic acid injections for osteoarthritis pain.
6.
Zhai S, Huang B, Yu K.
The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis.
J Int Med Res.
2020 48(4): 0300060519895868.

[6].
Farkas B, Kvell K, Czömpöly T, Illés T, Bárdos T.
Increased chondrocyte death after steroid and local anesthetic combination.
Clin Orthop Relat Res.
2010;468(11):3112–3120.

[7].
Mödder G.
(2013) Radionuclide Therapy of Inflammatory Joint Diseases (Radiation Synovectomy, Radiosynoviorthesis).
In: Baum R.
(eds) Therapeutic Nuclear Medicine.
Medical Radiology.
Springer, Berlin, Heidelberg.

[8].
Uson J, Rodriguez-García SC, Castellanos-Moreira R, O'Neill TW, Doherty M, Boesen M, Pandit H, Möller Parera I, Vardanyan V, Terslev L, Kampen WU, D'Agostino MA, Berenbaum F, Nikiphorou E, Pitsillidou IA, de la Torre-Aboki J, Carmona L, Naredo E.
EULAR recommendations for intra-articular therapies.
Ann Rheum Dis.
2021 Oct;80(10):1299-1305.
doi: [9] .
1136/annrheumdis-2021-220266.
Epub 2021 May 25.
PMID: 34035002; PMCID: PMC8458067.

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