Joint injections information sheet

Contact

Phone: (02) 9382 1597

EmailSCHN-SCHRheumatology@health.nsw.gov.au

Introduction

Some children with rheumatologic conditions, such a JIA, may require injections of steroid into a joint.

It is effective because it does two things, treats the inflammation locally, and provides pain relief. Aim is to prevent future joint damage.

About the treatment

The medical term for a joint injection is intra-articular injection. The procedure involves inserting a needle into the space between the bones in a joint to inject a long-acting steroid called Triamcinolone hexacetonide. Sometime excess fluid will be removed from the inflamed joint.

Your doctor will explain the risks and side effects of the joint injection before the procedure and ask you to sign a consent form as per other treatments. 

Don’t hesitate to ask all your questions, it’s important you understand the treatment and feel comfortable with the procedure.

The doctor will tell you which anaesthetic is suitable for your child when they receive the joint injection.

Ways to give joint injections

Joint injections are given under anaesthesia or nitrous oxide (laughing gas) depending on their age, joint location and number of injections needed. 

Under general anaesthetic

For young children, giving the injection under general anaesthetic (GA) allows us to safely inject the medicine into the joint without the worry that the child may move.

This is often in the best interest of the child as they are too young to understand and follow the necessary instructions.

For the very small joints (such as those in the hands or feet) or deep joint (hips), children can have the injection by guided ultrasound. The GA allows this to be done safely and with minimal worry for the child.

If several joints require treatment, it’s our experience that the treatment is easier for the child for this to be done under a GA. It minimises worry and distress for the child.

Under nitrous oxide (laughing gas)

For older children/adolescent who need several joints treated, nitrous oxide is very effective tool and avoids the need for GA.

Nitrous oxide is often called laughing gas. It gives a light anaesthetic to reduce pain during the procedure. The nitrous oxide is mixed with oxygen and administered through a mask over the child’s mouth and nose.

Some children will receive an additional medicine called Midazolam, which makes the child feel a bit sleepy and relaxed. It also makes them forget the procedure.

Children receive procedure preparation and support through the Hospital’s Child Life specialists who are skilled at explaining complex procedures to children and help them relax before the procedure.

With local anaesthetic

For older adolescents, there is an option to only have local anasethetic for a joint injection. Each young person will be assessed by the clinician on their capacity to have a joint injection with topical anesthetic cream with local anaesthetic. This will be a collaborative decision between the patient and their team.

Side effects

The side effects include a very remote risk of joint infection and possible later skin atrophy (more common in small children).

The injections can cause stinging to the joint and some children find this painful and uncomfortable. The younger a child is, the harder it is for them to manage without some sort of pain relief.

After the procedure

Many parents ask how long it takes before they see a response to the steroid injection. Many patients report that within a few days they are able to move the joint more freely and experience less pain. Sometimes it can take up to two weeks, it depends on which joint(s) were injected.

If your child is on anti-inflammatory medicine, it is suggested you continue that for a couple of days. It can then be stopped and restarted if the child continues to experience pain.

The day following the procedure, we suggest that children not participate in strenuous exercise such as sport or dance training, but they are welcome to continue normal daily activities, attend school, and ‘play’ as if they feel up to it.

After 48 hours, if your child wants to return to sport and feels comfortable, they are welcome to.