Injections into joints - benefits and risks

Injecting into the joint is a procedure that is effective but abuse will cause many unfortunate accidents.

Inject into the joint
(Photo: medicalmultimediagroup)

Using a small needle injected into the joint and some software around the joints is a common procedure used in hospitals to treat certain diseases such as osteoarthritis, inflammation of the tendon points, arthritis, arthritis infection in some chronic diseases (such as rheumatoid arthritis, ankylosing spondylitis .).

Injections into joints

Commonly used injections into joints are corticosteroids, hyaluronate sodium (hyasyn).

Corticosteroids : Often used as suspension, with drugs such as prednisolone, methylprednisolone, triamcinolone.

Clinical studies of knee corticosteroids show that: If a single dose of 20 mg of triamcinolone (equivalent to 25 mg prednisolone) is used, the analgesic effect lasts for 1-4 weeks. If using triamcinolone 40mg dose, the analgesic effect lasts for 16-24 weeks (Raynauld J, 2003). The 40mg dose of triamcinolone is also the recommended dose of the American Rheumatology Association. Usually repeat this dose once every 3 months, lasting for 2 years. In the case of joint effusion causing inflammation of the synovial fluid, corticosteroids act as an anti-inflammatory agent, so the selection of the fluid in parallel with the injection of corticosteroids leads to better drug response.

Particularly, the injection of corticosteroids into the tendons to repair lesions of the synovial membrane, tendons around the veins, where the tendon is attached and the major is applied, but so far there is no solid reasoning basis nor have forest evidence. Convinced to prove effective but encounter many disasters. Except for the injection of the index finger that shows tendon and inflammatory degeneration, there are some improvements (Lambert, 1992), most of the experimental injections in the rotator cuff tendinopathy (external elbows) ) and heel tendonitis (achiles) are not much better than the control group.

Hyaluronate sodium (hyasyn)

Hyaluronate is a natural substance in the human body, has a high concentration in the joint and fluid tissues that play the role of lubrication, shock, and joint protection. The reduction of hyaluronate in synovial fluid, articular cartilage loss is the main point in osteoarthritis. Drugs work:

Legend injection ( hyaluronate sodium ) - Photo: bullwrinklerx Pain relief (due to PEG birth reduction, bradykinin birth reduction, pain receptor suppression). anti-inflammatory (due to inhibition of PGE inhibition, blocking cytokine effects). Inhibiting articular cartilage degradation, promoting joint cartilage cell synthesis.

Clinical studies show: For patients over 40 years of age, osteoarthritis of knee pain, decreased synovial fluid or stiffness after 5 weeks of treatment with nonsteroidal anti-inflammatory drugs and paracetamol combined with sodium hyaluronate (at dose Each week 25mg x 5 weeks) up to 93% of patients are free of pain, if using nonsteroidal anti-inflammatory drugs and paracetamol without combining with hyaluronate sodium, only 10% of patients have similar effects (Thai Thi Hong English, 2005).

In addition to possible local redness, injection of corticosteroids, hyaluronate sodium into the joint has no significant side effects. Previously there was concern that injection of corticosteroids into the joint could promote joint and muscle atrophy, now many studies suggest that this progression is not due to the injection of corticosteroids into the joint but due to the inherent nature. There are diseases.

While there is no cure (except for expensive joint replacement), injections of corticosteroids, hyaluronate sodium into joints meet the patient's expectation: Improving symptoms and safety at low cost.

Accidents due to abuse of injection into the joint

Perform an injected joint procedure at home or at a medical facility that is not qualified to have errors.

About indications : Osteoarthritis physicians only use the articulation procedure when taking nonsteroidal anti-inflammatory drugs is not effective (severe disease) and not used in cases of septic arthritis or infection at joint skin area. Because patients prefer to use a joint injection procedure (because other people use it quickly) and are not qualified at home or at the grassroots level, they are assigned to all cases. Arthritis including mild cases is not necessary and is indicated for both cases of septic arthritis.

Some people also use one or more other drugs such as vitamin B12, antibiotics, nonsteroidal anti-inflammatory drugs or mix them with the injection of corticosteroids into the joint. The use of the above drugs is not strictly indicated, mixing drugs together or mixing with suspension of corticosteroids destroys the dosage form. This will cause bad consequences: causing a strong inflammatory reaction in the synovial membrane, damaging the synovial organization, articular cartilage, making the joint swollen, leading to joint, loss of joint function. .

About injection : Do not know the position of anatomy, lack of expertise when operating, so it is not injected into the position, the drug does not go to the place needed, the effect will be poor. More dangerous, if injected into the muscles, bones, blood vessels, nerves around the joints will cause very bad consequences such as muscle atrophy, osteoporosis, loss of motor function. In addition, by injecting multiple times into one position and injecting too shallow will cause skin atrophy, loss of skin pigmentation in place. Rarely, sometimes the patient is too scared, by injecting too quickly or injecting it into the bloodstream, the patient may be dizzy, sweating, chest tightness, difficulty breathing.

Regarding facilities : At home or at some grassroots health centers, there is often no injection room and equipment to ensure aseptic sterility, leading to destruction of joints, joints, and very serious sepsis. causing disability or death if not detected early and treated with specific antibiotics, high doses.

In order to carry out the procedure of injection into the joint, there must be a specialized physician appointed to have an anatomical and skilled knowledge to inject in the right position; must have a place, equipment to ensure sterility. Patients should not easily accept this procedure at home, at the local health facilities do not have all the above conditions because it is easy to lead to dangerous accidents.

DS. BUI VAN UY