Injection Therapy – Part II (A Continuation of Part I )
Osteoarthritis (OA) is a condition which will affect essentially every human at some point in their life. As discussed in previous articles, the treatment of OA should be multi-modal. One of the more common treatments is injection therapy. In the past, injection therapy was limited to essentially only corticosteroids (steroids). However, there are now several other options.
If a patient has disabling joint pain from their OA, initial treatment usually includes more conservative therapies such as physical therapy, oral anti-inflammatory medications (NSAID’s), oral analgesic medications (pain relievers), activity modification, and weight loss, especially for the lower extremities (hip/knee joints).
However, if symptoms are severe or not controlled by the more conservative options, an injection of steroid can be tremendously beneficial. The steroid is used to decrease any inflammation associated with the painful joint. Although OA is not considered to be a significantly inflammatory condition, medical evidence suggests an inflammatory component to the condition.
Patients frequently express concern regarding the use of steroid. However, if used in a clinically appropriate manner, steroids can be therapeutically beneficial while minimizing the potential adverse effects. If a patient is diabetic, a corticosteroid will increase the serum glucose (blood sugar) levels generally for no more than 48-72 hours. Adjustments in the diabetic medication may control this temporary blood sugar elevation. Notably, the steroid used for OA joint pain, is not the anabolic steroids used by athletes to enhance performance. It is more akin to so-called “cortisone”. There are numerous steroid preparations available. Your physician can decide which steroid is most appropriate in your particular situation.
Other adverse effects of corticosteroids include toxic effects to the joint cartilage. If used excessively, corticosteroids have been associated with temporary elevations in blood pressure and accelerated bone thinning.
Joint Injection Procedure:
Traditionally, the joints were injected without image guidance. However, medical studies demonstrated that without this image guidance, the medication would not reliably get to the target area. So for instance, if your physician was injecting your hip without x-ray (fluoroscopy) or ultrasound-guidance, the medication would not be reliably in the hip joint which was targeted.
Therefore, the use of fluoroscopy or ultrasound has increased tremendously over the past decade or more. At NERA Spine, Sports & Pain Medicine, we utilize both ultrasound and fluoroscopy guidance in our offices located in Quakertown, Bethlehem, Scranton, and Easton.
Contrary to popular belief, the injections are relatively painless. If necessary, and especially with deeper joint injections, local anesthetic or numbing medicine can be applied to minimize discomfort from the injection itself. At the time of injection, if there is fluid in the joint it can be removed or aspirated, which may also provide greater pain relief.
Viscosupplementation refers to the injection of hyaluronic acid-derived preparations into the affected joint. There are several preparations available. Generally, the injections are done on a weekly basis for 3-5 visits. The use of viscosupplementation is only indicated for use in knee osteoarthritis and therefore insurance coverage could be limited. There has been recent medical controversy over the efficacy of hyaluronic injections, which continue to be used on a regular basis clinically. The hyaluronic acid injections are felt to be beneficial in maintaining joint health without the adverse effects of corticosteroid.
PRP (Platelet Rich Plasma):
More recently, PRP injection has been utilized by physicians in an effort to treat the pain associated with osteoarthritis. Additional benefits would include potential slowing of the arthritic process. There remains limited scientific evidence regarding the efficacy of this treatment; however the potential adverse effects are felt to be quite limited. The PRP can be performed in any joint.
In summary, the use of injections in the treatment of OA is an integral part of the multi-modal approach to this condition. There are several injection options available. Generally, these options will not be effective in severe joint arthritis, but can be helpful not only in relieving pain, but slowing the progression of the OA.
If you live or you are visiting the Lehigh Valley region, including Allentown, Bethlehem, and Easton areas and you are suffering from an acute or painful neurologic or musculoskeletal condition, consider making an appointment by calling (610) 954-9400 or schedule a doctor’s visit Online.