-- Question: Can Injections Into Arthritic Joints Be Harmful?
Answer: Well, the question about injection into arthritic joints is one that's very difficult to study. Corticosteroid injections into joints and tendons has been used for decades to treat inflammation and pain, and can be very effective when a single joint's involved or a single area, provided there's no infection there. Certainly, if there is an infection, that's what we consider, that's what we call a contraindication to doing injections, and at that point, clearly is dangerous.
Repeated injections have been associated with ligaments getting loose and atrophy of the cartilage, but many of the times this has been done, this has been in athletes, rather than patients with chronic arthritis. Most of the patients that we use these injections in are patients who've already got significant damage in their joints and the injections are used to try and alleviate the pain and discomfort that goes along with this.
It should clearly be used as sparingly as possible, and hopefully in conjunction, again, with some sort of oral therapy or biologic therapy that we can use to slow down or halt the disease, so we don't need to do it repeatedly. But, with that said, joint injections work very rapidly; they can be very effective.
Most of the times we use corticosteroids -- Kenalog, Aristospan, triamcinolone -- something along those lines, perhaps mixed with a Novocain or lidocaine mixture. There isn't any place for the viscosupplementation (injections of gel--like substances) and hyaluronic acid derivitives in rheumatoid arthritis; these are usually used for osteoarthritic patients.