Infiltrations intra-articulaires périphériques de corticoïdes

Abstract

Intra-articular injections of glucocorticoids are often used in the daily practice of rheumatologists. The different corticosteroids will be to use according to their characteristics and type of arthropathy. Contraindications will be strictly respected and their local and systemic adverse effects, although rare, must be known. The patient should have been informed of the risks and benefits of this treatment before infiltration and have given his agreement. The requirement to provide adequate information to patients and documenting that informed consent was obtained should never be neglected. Corticosteroid doses and type does vary with the structure injected and kind of arthropathy. Among the indications, the best are chronic inflammatory rheumatism, in case of persistent inflammation at a single site, in addition to a background treatment. The effect of intra-articular injections in osteoarthritis seems to be less consistent compared to that in inflammatory rheumatism but can be useful in case of acute inflammatory flare of osteoarthritis with pain and joint effusion. Excluding the knee, ideally after synovial fluid aspiration before injection, which can be easily infiltrated after joint palpation, others intra-articular injections, especially the deepest, will have to be realized today under ultrasound or radioscopy guidance. Guided injections by sonography are now very useful to be sure that injection is really intra-articular and to avoid risk structures. Insoluble long-acting crystalline form of corticosteroid such as triamcinolone hexacetonide must be privileged in case of chronic inflammatory rheumatism. The rheumatologist should keep in mind that it is recommended that intra-articular glucocorticoid injections in an individual joint should not be given more frequently than 3 or 4 times a year, to prevent glucocorticoid-induced joint damage and avoid local or systemic adverse effects.