In the United States, tens of millions of individuals suffer from osteoarthritis and rheumatoid arthritis. This leads to a tremendous amount of symptomatic hip, knee, shoulder, ankle, lbow, wrist and spinal arthritis that is symptomatic due to an arthritic condition. Surgery for joint arthritis is a last resort procedure. This is because arthritis is not a fatal condition and a procedure performed for arthritis is an elective surgery.
For over 50 years now, the most common medicine used for joint injections is cortisone Other names for cortisone include corticosteroid or simply, steroid. In the 1950s,corticosteroid injections were introduced and used commonly for rheumatoid arthritis. After a few decades, it was discovered they also worked well for osteoarthritis, which is the wear and tear form of degenerative arthritis.
Once steroid injections became commonplace for osteoarthritis, some initial studies showed in animals that these injections could potentially harm the cartilage. Subsequent studies in larger animals showed no cartilage damage from steroid injections so they became even more popular for joint injections in humans. At this point in time, steroid injections into joints are the gold standard for Pain Management.
Also worth mentioning as joint injections are hyaluronic acid. The substances are commonly known as Orthovisc, Synvisc or Hyalgan. Multiple studies have shown beneficial effects for hyaluronic acid injections for joints and they are commonly used today.
Hyaluronic acid injections were FDA approved back in 1997 for the knee, and are now routinely used in other joints as well. The hyaluronic acid is obtained from rooster combs and works to lubricate the joint. One of the native components of joint fluid is hyaluronic acid, and it effectively acts as the human equivalent of motor oil.
Hyaluronic acid treatment is known as viscosupplementation and they can help protect cartilage along with lubricating the joint. They may potentially help form more cartilage, however, studies have not shown this definitively.
Regenerative Medicine for Joint Injections
The latest step forward in joint injections for osteoarthritis and rheumatoid arthritis include regenerative medicine substances.
These include stem cell substances along with platelet rich plasma, commonly known as PRP. The stem cell injection material is obtained either from the patient’s own body or from elsewhere. There are amniotic membrane derived injections that contain a large amount of stem cells along with hyaluronic acid that are showing excellent results in small studies to date. Using the patient’s own stem cells may include fat derived or bone marrow derived stem cell substances. There are really only anecdotal reports so far showing benefit, no large studies.
One up and coming type of joint injection, platelet rich plasma, involves a simple blood draw from the patient with a centrifuge process to separate out the platelets and growth factors from blood. Once the PRP is separated out, it is injected into the symptomatic joint area. The platelets and growth factors are showing significant benefits in small studies so far for arthritis. One of the significant benefits of PRP is its ability to call in the body’s stem cells to help promote repair and regeneration.
Most joint injections are performed in an office setting. A joint such as the hip, is often necessary to use fluoroscopy as there are some significant dangerous soft tissue structures that should be avoided with the injection.
With a knee injection, it’s so superficial it’s easy to do right in an exam room just by palpating for landmarks.
Once adequate placement is achieved with the needles, they are heated up to approximately 80 degrees Celsius for about 90 seconds. This part is termed medial branch thermocoagulation.
The RF procedure deadens the tiny nerve endings supplying sensation to the painful joints, providing pain relief that is typically long-term.
By and large, joint injections for osteoarthritis work exceptionally well. Studies for steroid injections have shown over a 75% good to excellent results. These injections can be repeated every few months to obtain additional benefit.
Hyaluronic acid injections have been looked at extensively. One of the largest American studies showed approximately 80% of patients received excellent Pain Relief for over six months.
Studies for regenerative medicine injections are ongoing and we should know in the next few years exactly how well they work for joint osteoarthritis.
Joint injections have very low risks, under 1% complications. There is a small risk of infection, bleeding or with steroid, temporary increases in blood sugar or weight gain, or allergic reaction.
One interesting complication of hyaluronic acid injections is what is called a pseudo-infection. This is not a true infection but may look like it and it usually resolves within a fewNevada Pain Clinics days.
One issue that may be seen with platelet rich plasma is increased pain due to the inflammation sparked up with the injection. This typically resolves within 48 hours and then Pain Relief starts to “kick in”.