Osteoarthritis and Injections

In some cases, the joint can be affected with a certain solution that can relieve some osteoarthritis symptoms.

Common injections are:

• Corticosteroid Injections
• Vicosupplementation

Read more details about Injections.

Corticosteroid Injections

Your doctor may choose to inject the affected joint with a solution containing a corticosteroid medication such as:

• Methylprednisolone (Medrol)
• Triamcinolone (Aristocort)

The steroid injection can help decrease inflammation and pain in the joint. Sometimes, excess joint fluid will be removed from the joint just before injecting the steroid medicine.

Steroid injections often have to be repeated every several months. Most doctors believe that no more than three or four such injections should be given in a year. More than that number may itself cause damage to the articular cartilage.

Vicosupplementation

Viscosupplementation involves injecting the affected joint with a fluid containing a substance called hyaluronic acid. Hyaluronic acid is a chemical found in normal cartilage and in normal joint fluid, which is vital to the lubrication of the joint surface.

Viscosupplementation uses laboratory-produced substances called:

• Sodium hyaluronate (Hyalgan)
• Hylan G-F 20 (Synvisc)

Viscosupplementation is thought to:

• Lubricate the joint
• Allow the joint to glide more freely
• Decrease pain and stiffness

Growing but definitive evidence suggests that the natural substance hyaluronic acid may help reduce osteoarthritis symptoms when it is injected directly into an affected joint.^{163-166,173,195} However, there is absolutely no reason to believe that oral hyaluronic acid should help, and one study failed to show any significant benefit.¹⁹⁴

Prolotherapy

Prolotherapy is a special form of injection therapy that is popular among some alternative practitioners. A double-blind, placebo-controlled study evaluated the effects of 3 prolotherapy injections (using a 10% dextrose solution) at 2-month intervals in 68 people with osteoarthritis of the knee.¹¹⁰ At 6-month follow-up, participants who had received prolotherapy showed significant improvements in pain at rest and while walking, reduction in swelling, episodes of "buckling," and range of flexion, as compared to those who had received placebo treatment. The same research group performed a similar double-blind trial of 27 individuals with osteoarthritis in the hands.111 The results at 6-month follow-up showed that range of motion and pain with movement improved significantly in the treated group as compared to the placebo group.

Bee Venom Injections

Limited evidence supports the use of bee venom injections for osteoarthritis.¹⁶⁸

Arthritis Foundation website. Available at: http://www.arthritis.org/ .

Conn’s Current Therapy . 54th edition. W.B. Saunders Company; 2002.

Manek NJ, Lane NE. Osteoarthritis: current concepts in diagnosis and management. American Family Physician . 2000;51(6). Available at: http://www.aafp.org/afp/20000315/1795.html.

National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .

Transcutaneous electrical nerve stimulation. InteliHealth website. Available at: http://www.intelih... . Updated May 2008. Accessed December 11, 2009.

12/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Rutjes WJ, Nuesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.

10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675.

110. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000;6:68-70,72-74,77-80.

163. Modawal A, Ferrer M, Choi HK, et al. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005;54:758-767.
164. Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic Acid for osteoarthritis of the knee. J Rheumatol. 2006;33:951-956.
165. Bellamy N, Campbell J, Robinson V, et al. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005;CD005321.
166. Salk RS, Chang TJ, D'Costa WF, et al. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am. 2006;88:295-302.
168. Lee JD, Park HJ, Chae Y, et al. An overview of bee venom acupuncture in the treatment of arthritis. Evid Based Complement Alternat Med. 2005;2:79-84.
173. Fernandez Lopez JC, Ruano-Ravina A. Efficacy and safety of intraarticular hyaluronic acid in the treatment of hip osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2006 Sep 14. [Epub ahead of print]
194. Kalman DS, Heimer M, Valdeon A, et al. Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint®) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial. Nutr J. 2008 Jan 21.
195. Petrella RJ, Cogliano A, Decaria J. Combining two hyaluronic acids in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Clin Rheumatol. 2008 Jan 17.