As we wrap up Arthritis Awareness Month in Canada, let’s talk about osteoarthritis and the potential role of intra-articular injections.
What is osteoarthritis?
Osteoarthritis is the most common type of arthritis – it is a chronic inflammatory process that leads to the deterioration of cartilage and bony changes within the joint. As the main cause of disability in those over the age of 65, osteoarthritis can have a significant impact on pain, mobility and quality of life in those afflicted by it. Although osteoarthritis can occur in any joint, it is most common in the weightbearing joints (hips and knees), as well as hands and spine. Risk factors for osteoarthritis include: genetics, increased age, obesity, trauma/injury, and overuse of the joint.
What are intra-articular injections?
Intra-articular injections refers to a substance being injected into the painful joint with the goal of pain reduction and maintaining as much mobility and function as possible. People with osteoarthritis are one of the main populations that receive this treatment. There are a few different types of injections used, however corticosteroid injections tend to be the most readily available and affordable.
Corticosteroid injections:
Corticosteroid injections are used to reduce inflammation in the joint space. Because this inflammatory response can lead to more damage in the joint, the goal is that these injections not only give pain relief, but also may decrease the rate of arthritis progression. Newer research has shown that repeated use of these injections may actually lead to increased damage to the cartilage, as well as surrounding tissues, so steroid injections tend to be limited to a maximum of four per year. Pain relief from these injections tends to be short lived, lasting 1-8 weeks.
Hyaluronic Acid (Viscosupplementation) Injections:
This is another tool that can be used for pain management in osteoarthritis. It acts differently than steroids; It is used to lubricate the joint and help with shock absorption, as well as to promote natural hyaluronic acid production. It has been shown to have some effect anywhere from 8-24 weeks after injection, but tends to be more effective in those with less severe osteoarthritis on imaging. There are fewer risks associated with these injections, however research indicates this may not be the most impactful in terms of pain relief. It may be a useful tool in some cases, like if someone has already tried multiple steroid injections.
Platelet Rich Plasma (PRP) Injections:
PRP is the process of using platelets from your own blood and re-injecting them into the joint to promote healing. The goal of PRP is to promote the release of growth hormones which decreases inflammation and the breakdown of tissue, and encourage tissue regeneration. There is a not a lot of consensus on the use of PRP in the management of osteoarthritis due to the lack of research on the benefits, risks, and administration of PRP injections.
What are other options?
While intra-articular injections may offer some short term pain management in osteoarthritis, they are considered a somewhat invasive option, so other treatment modalities are often recommended first. Pain medication, exercise, activity modification, bracing, and physiotherapy are all great conservative measures to start with when you are struggling with pain associated with osteoarthritis. If these options are not successful, it’s important to discuss with your physician what your options are, which may include things like intra-articular injections.
If you are struggling with osteoarthritis and are interested in trying physiotherapy to help with pain and function, feel free to reach out to the clinic. Our PEAK osteoarthritis program might be a good fit for you!
Resources:
Kopka M, Sheehan B, et al. Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine. 2019;7(7). doi:10.1177/2325967119860110
Pavone V, Vescio A, Turchetta M, Giardina SMC, Culmone A, Testa G. Injection-Based Management of Osteoarthritis of the Knee: A Systematic Review of Guidelines. Front Pharmacol. 2021 Apr 20;12:661805. doi: 10.3389/fphar.2021.661805
Testa G, Giardina SMC, Culmone A, Vescio A, Turchetta M, Cannavò S, Pavone V. Intra-Articular Injections in Knee Osteoarthritis: A Review of Literature. Journal of Functional Morphology and Kinesiology. 2021; 6(1):15. https://doi.org/10.3390/jfmk6010015