Injections for Arthritis

What injections are available in the treatment of arthritis?

There are different types of injectionsavailable in the non-surgical treatment of arthritis including:

These may be injected into the affected joint, with the goal of reducing painin order to participate in other activities that help alleviate arthritis (eg exercise).

Cortisone Injections

What is cortisone?

Cortisone is a corticosteroid medication. Corticosteroids are used to treat many conditions, particularly inflammatory conditions.

Although cortisone injections are often called ‘steroid’ injections, these are not the same as anabolic steroids such as testosterone.

Why have a cortisone injection?

A cortisone injection is mainly given to relieve pain and inflammation. Occasionally it is given to help make a diagnosis.

Cortisone injections can alleviate symptoms but they do not cure arthritis.

Where is the injection given?

The injection is given directly into the joint space, where it comes into contact with the inflamed tissues on the surfaces of the joint.

What happens during a cortisone injection?

If your surgeon believes that Cortisone injections are indicated to treat your condition, they will write a referral for you to have injections administered into specific joint spaces.  The Cortisone injections are then performed under radiographic (usually ultrasound or CT) guidance in a radiology practice.  The procedure does not take long, although you might be asked to stay for a short while afterwards for observation.

The injection is usually done with you sitting or lying down (depending on which joint is being injected). Your doctor may apply a topical anaesthetic and may also apply some ultrasound gel, if the injection is being guided by ultrasound.

Through a disinfected site, your doctor will inject a small volume of cortisone into your joint. There may be local anaesthetic mixed with the cortisone, but you might still feel a slight pinching or burning sensation.

How long does the effect from the injection last?

A cortisone injection may last somewhere between 6 weeks and 6 months.

Are there any complications?

Possible complications include:

  • an allergic reaction (to the local anaesthetic more than the cortisone)
  • pain and swelling
  • infection
  • skin lightening in people with darker skin
  • elevated blood sugar in people with diabetes

Platelet Rich Plasma(PRP) Injections

What is platelet rich plasma?

Platelet rich plasma (PRP) is made from a sample of your own blood. Your blood is made up of plasma (the ‘water’ part that contains proteins and nutrients) and cells (red cells, white cells and platelets).

PRP is blood with the red cells and white cells removed, but with a higher concentration of platelets than normal blood. Platelets are activated during the healing process to release growth factors that can further influence healing.

Although PRP has been in use for 30 years, it is considered novel therapy.

How is PRP made?

PRP is made from a sample of your blood. Different doctors have different ways to prepare it. Generally, a small amount of your blood is collected into a tube and that tube is then spun in a high-speed centrifuge. Spinning separates the blood into layers (red cells at the bottom, white cells and platelets in the middle and plasma at the top). The platelet layer at the top of the cells is removed, together with some plasma, to create platelet rich plasma ready for use.

Why have a PRP injection?

A PRP injection may help damaged tissue heal. Experts are not yet sure how it works, but some theories are that PRP:

  • inhibits inflammation
  • increases production of lubricating joint fluid
  • stimulates new cartilage growth
  • alters pain receptors

PRP injections do not work for everyone. Our specialists at Orthopaedic Clinics Gold Coast will discuss whether you are a good candidate for PRP injections.If you decide to have PRP injections, you will be advised about what medications you need to avoid (eg anti-inflammatories and blood thinners) before and after treatment.

Where is the injection given?

If your surgeon believes that PRP injections are indicated to assist treating your condition, they will write a referral for you to have injections administered into specific joint spaces.  The PRP injections are then performed under radiographic (usually ultrasound or CT) guidance by a doctor skilled in the procedure.

What happens during a PRP injection?

The procedure starts with taking a blood sample. It takes 45–90 minutes to prepare the PRP injection from the sample.

Once the PRP is ready, the injection site is cleaned. Your doctor may apply some ultrasound gel, if the injection is being guided by ultrasound. Then a small volume of PRP is injected into your joint.

A bandage is applied and you can then go home, but you should try to rest the joint for a couple of days.

How long does the effect last?

There is no standard duration of effect. It can take a while to work, with maximum benefit being felt 6–12 weeks after the injection.It may be that a series of injections is required.

Are there any complications?

The PRP stimulates a response from your body, so it’s common for there to be some pain and swelling for a few days, or even up to a few weeks.

The main complication is that the PRP injection may not work for you.

Stem Cell Injections

What are stem cells?

Stem cells are cells that can regenerate themselves and turn into different types of cells. We all started as a single stem cell (embryo cell).

The most common stem cells used in treatments are mesenchymal stem cells. These have the potential to develop into cartilage, bone and fat cells. Mesenchymal stem cells are usually harvested from your own body tissues (eg fat, blood or bone) and then prepared to create a concentrated solution for injection.

Why have a stem cell injection?

There is still a lot of debate around the use of stem cells for arthritis. There is potential that the injected stem cells will develop in cartilage cells, thereby regenerating the worn cartilage in a joint affected by arthritis. But this effect is not certain.

Our specialists at Orthopaedic Clinics Gold Coast will discuss whether stem cell injections are appropriate for you at your visit.

Lubricating Fluid Injections

What are lubricating fluid injections?

One of the common treatments for arthritis is an injection of lubricating fluid into affected joint. The fluid contains hyaluronic acid, which is present in higher concentrations in normal healthy joint fluid and in lower concentrations in arthritic joints.

The hyaluronic acid used is man made.

Why have lubricating fluid injections?

Hyaluronic acid injections are given to reduce friction and improve movement of your joint so that you can participate in activities that benefit the joint (eg exercise, physiotherapy).

The injections may alleviate pain and slow the progression of arthritis down, but they will not cure your arthritis.

Our specialists at Orthopaedic Clinics Gold Coast will advise you if you’re a good candidate for this treatment.

Where is the injection given?

The injection is given directly into the joint space.

What happens during a lubricating fluid injection?

The procedure is done in your doctor’s office and only takes a few minutes to do.

The injection is usually done with you sitting or lying down (depending on which joint is being injected). Your doctor may give a local anaesthetic and may also apply some ultrasound gel, if the injection is being guided by ultrasound.

Through a disinfected site, your doctor will inject a small volume of hyaluronic acid into your joint. If your joint is swollen, your doctor may remove some fluid before putting more in.

How long does the effect from the injection last?

An injection of hyaluronic acid can provide pain relief for 3–12 months. The amount of relief varies from person to person.

The injections can be repeated, but you may find that subsequent injections don’t help as much as the first one.

 Are there any complications?

Complications are usually minimal. You may find that the joint is sore, swollen and stiff for 1–2 days after injection.