What is it a joint injection?
A joint injection involves an injection of a long-acting steroid medicine into the joint space of an inflamed joint. This is done under either a general anaesthetic or with the use of Entonox (gas and air) depending on the age and ability of the child to tolerate the procedure. By giving a relatively small dose of steroid directly to the site of the inflammation we get an excellent response, but avoid almost all the side-effects associated with steroids if they are taken orally.
When is this treatment used?
This treatment is frequently used as the first-line treatment for children with arthritis, but is also often used to control “flare-ups” of arthritis if they occur. Whil we often give treatment with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen and Naproxen to children when they are diagnosed with JIA, they only provide partial relief of symptoms and rarely fully suppress the arthritis. The only joints we do not inject are those around the spine. All the other joints in the body are regularly injected by us, including the small joints in fingers and toes.
How effective is this treatment?
Most children respond very well to joint injections with complete relief of swelling and pain within 24-48hrs after the injection. The arthritis usually remains completely quiet for 6-12 months, occasionally even longer. Only a very small number of children do not respond to this treatment at all.
What if my child has to have a general anaesthetic?
Children under eight, or those who are having multiple joints injected, usually have these done under a general anaesthetic. All general anaesthetics are performed under the supervision of a specialist children’s anaesthetist. All injections are done either by, or under the direct supervision of, one of the consultants.
Arrangements will be made for your child to be admitted to hospital. You will receive instructions from the hospital about one week before and this will include advice on missing food/drink before the procedure.
Almost all joint injections are done on a regular list on Thursday mornings. Your child does not have to stay overnight in the hospital and will be allowed to go home around lunchtime.
Are there any precautions we should take after a joint injection?
Your child should avoid sports and PE for the first 24 hours following the joint injection, although this need not be strictly enforced if a patient is pain-free. Following this regular activities should be resumed, this includes going to school, taking part in PE, etc.
Are there any complications?
- Subcutaneous fat atrophy (loss of fat under the skin) at the site of injection is an uncommon complication, but is more likely when the wrist, fingers, toes, or the small joints of the foot are injected. This usually presents as a small dimple at the injection site and may resolve over time. Sometimes the skin at the same site loses its normal pigmentation (skin colour) as well.
- Cushings Syndrome is very rarely seen after joint injections. This is a transient reaction to the steroids and is usually only seen when a large number of joints have been injected at the same time. It produces a transient rise in appetite and occasionally the child may gain some weight but this usually only last for a week or two.
- Infection of the injected joint is very rare. If after the injection your child develops a very painful, swollen, hot and red joint, then you should contact the Paediatric Rheumatology Sisters or your GP urgently, ie, the same day.