Why do we take out fluid or inject medicines into joints ?

Q.1. Why do we take out fluid or inject medicines into joints ?

Rheumatologists/ doctors give joint injections to either remove fluid from joints for testing and/or to inject medicines (steroids or something else) in them. Sometimes we remove fluid and inject medicines together in same sitting.

Q.2. Are joint injections necessary? What are benefits of joint injections?

• Sometimes it is very important to get fluid out of joint and send it for testing to reach a proper diagnosis.
• When we inject medicines (cortisone. steroid or gel like injections) into joints, medicine reaches directly. So relief is fast and can be long lasting.
• Rheumatologists or orthopedics use joint injections when they feel that it will give better results than medicines or will have additional benefits along with medicines.
• Sometimes when a single joint is active or painful, direct injection into the joint can be very effective. Such patients may not need oral medications.

Examples of giving joint injections

• In a patient with suspected joint infection (septic joint) or gout (uric acid arthritis), we have to take out joint fluid and send it for testing. This helps us to reach a proper diagnosis.
• Patients with Rheumatoid arthritis (RA) can have multiple swollen joints. Sometimes when we give treatment for RA, many joints respond and swelling goes away. However, if swelling persists in 1-2 joints, we can inject steroids (cortisone or kenacort) into them. This helps us to control inflammation and prevent joint damage.

Q.3 Why do we remove fluid / water from the joints? Does it harm the joints in future ?

As mentioned above, we remove fluid from joints to test it for infection, gout arthritis, etc. Sometimes in arthritis joint we remove fluid and then inject medicines. This helps in giving patient better relief.

Normally our joints contain very little amount of fluid. When there is an infection or inflammation excess fluid can accumulate into a joint. Removing this fluid for testing or giving relief does no harm to the joint.

Q.4. Does it hurt a lot when we inject joints ?

Not really. Normally this injections hurt less than injections applied in buttocks or intramuscularly. One can easily go home after joint injections.

Q.5. What precautions are to be taken after we inject joints ?

After joint injection, one should avoid heavy work with that joint. Do not exercise for 24-48 hours. One can carry out normal day-to-day light duties.

For eg : After knee injection, do not drive for long or go on long walks or do knee exercises for 24-48 hrs. They can do light activities, they do not require complete bed rest. After 24-48 hours of joint injection, one can resume their normal activity or exercises.

Q.6. How many times can we repeat injecting medicines into same joint ?

• Normally injections of Corticosteroid (like Depomedrol or kenacort or another steroid) medicine will not be repeated before 3 months.
• Hyaluronic (gel like) injections are injected weekly for 6 weeks. Some gel injections are given once every 6 months.
• We remove fluid from joint whenever necessary.

Q.7. What precautions should I take or what should I tell my doctor before joint injections ?

Do not come for injection empty stomach. At least have a light meal.
Always tell doctor

• If you are suffering from any infection or on taking any antibiotics
• If you have any allergies
• If you have diabetes and sugars are uncontrolled
• If you have any surgeries or any procedures planned
• If you have suffered any major medical issue recently
• If you are on blood thinners

In above scenarios, the doctor might avoid or delay joint injection.

Q.8. What are the side effects or disadvantage of such injections?

Joint injections are very safe and if used correctly, they can give very good relief. Also, if a qualified doctor gives injection he/she makes sure that all things go smoothly. The following issues can still arise during or after joint injection,

• Sometimes allergic reactions can occur. We usually give joint injection in a hospital or clinic setting to deal with it.
• Immediately after injection one may feel some warmth or light-headedness. This feeling usually passes away in minutes. Patients can usually go home immediately after injection.
• Whenever we inject something there is always a chance of infection. However joint injections are very safe. Most studies have shown that rate of infection is less than 1 in 10000 to 30000.  The author of this article has given over 1000 joint injections and has not seen any major complication.
• After getting steroid medicine by joint injection, 2-3% people can suffer from increased pain and swelling in a joint for 1-2 days. We usually see the good effect of steroid medicine after 48-72 hours.
• Sometimes, white spot develops at the area of injection which take around 2-6 months to disappear.

Q.9 Are joints injected directly or using some imaging or Xray?

Many joints can be injected directly under clinical guidance. However, sometimes we inject with help of a sonography machine .

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