Periarticular administration is intra-articular injection. Joint injection for arthrosis of the knee joint

A number of joint diseases require not only oral medication, but also special injections. Here we are talking about periarticular administration. This is the injection of drugs into the periarticular tissues. That is, in the ligaments and muscles that surround the joint. What diseases is the procedure indicated for? Where exactly is the injection injected? Are there any contraindications? How exactly is it done? We will give answers to these and other important questions in the article.

What diseases is the procedure indicated for?

Periarticular administration is an injection of certain medications, which are shown, respectively, for pathologies of the knee joint. They can be diagnosed both in a number of rheumatic conditions and can be independent degenerative, inflammatory processes originating in periarticular structures.

Periarticular administration is a procedure necessary for a number of diseases characterized by various foci of inflammation. In particular, with the following pathologies:

• Tendonitis and tenosynovitis. In cases where tendons or tendon sheaths are inflamed.
• Bursitis. When a patient has a synovial bag inflamed.
• Tenobursitis. Simultaneous inflammation of both the tendon and tendon bag.
• Ligamentitis. Inflammation of the articular ligaments.
• Fibrositis. With this pathology, fascia and aponeurosis become inflamed.
• Myotendinitis. Inflammation of the muscle adjacent to the tendon.
• Active arthritis. Especially with an effusion in the joint cavity, which is observed with the rheumatoid form of the disease, seronegative spondylitis, or inflammatory processes in the connective tissues.
• Reactive synovitis of various origins. It is observed with osteoarthritis, trauma or gouty arthritis.

Where is the injection injected?

Periarticular administration is, as we have already noted, an injection into periarticular soft tissues. These include the following:

• Tendons and synovial sheaths of tendons.
• Synovial bags are bursa.
• Enthases. That is, locations where ligaments, tendons and joint capsules will connect to the bone.
• Ligaments.
• The muscles surrounding the joint.
• Aponeuroses are wide tendon plates.
• Fascias are connective tissue membranes that cover the muscles.

When carrying out intraarticular injection, a specialist needs to pay attention to the following:

• The technique is used preferably in the presence of inflammatory processes in a specific location of the joint or periarticular tissue.
• If inflammation has affected vast areas, the drug is administered mainly in focal zones.
• A similar treatment method must be applied to patients with contraindications to other methods of therapy for inflammation, pain in the joints and / or soft periarticular tissues. In particular, with diseases of the gastrointestinal tract, peptic ulcer at the stage of exacerbation, individual intolerance to certain medications.
• Intra-articular and periarticular injections are also used in case of ineffective systemic anti-inflammatory treatment.

When is this treatment used?

Periarticular administration of drugs in most cases involves injections of corticosteroids, glucocorticosteroids. Such drugs have a powerful anti-inflammatory and analgesic effect. Such treatment has been effectively used in inflammatory diseases of both joints and periarticular tissues for about 50 years.

But it should be noted that intra-articular administration of drugs is an auxiliary (less often - main) therapy. It is prescribed due to the fact that it is possible to get a quick effect: reduce or completely eliminate inflammation, and with it pain, improve or restore the function of both the joint and the limb as a whole. Such treatment can be prescribed in the following conditions:

• Active arthritis.
• Reactive synovitis.
• Enteritis.
• Periarthritis
• Tendinitis.
• Other inflammatory periarticular processes of various genesis, with the exception of only infectious ones.

Both periarticular and intraarticular injections of drugs are widely used in the treatment of arthrological patients. Patients may be diagnosed with the following diseases:

• Arthritis is rheumatoid.
• Osteoarthritis with synovitis.
• Peripheral Arthritis
• Gouty arthritis.
• All kinds of periarticular syndromes.

A similar treatment technique is universally used both in a hospital setting and in an outpatient clinic setting. Therapy helps to reduce the time of industrial, domestic disability of patients.

Safety procedure

Complications of intra-articular injections are primarily due to the fact that specialists of a wide profile prescribe them to patients without confirmed need. Various drugs are introduced, the number of injections may be too numerous.

In those cases when the sessions are carried out repeatedly, without proper indications and taking into account contraindications, when the choice of the drug or its dosage is not justified, serious consequences of this, in fact, safe minor surgical procedure can be observed. Negative consequences are possible if the doctor violates the technique of intra-articular injection. And also if you do not follow the important rules of asepsis and antiseptics.

Absolute and relative contraindications

Hyaluronic acid injection into the joint is the most common example of intra-articular injection. This procedure allows you to return mobility, freedom of movement. The fact is that hyaluronic acid not only brings the necessary fluid to the tissue, but also is able to hold it for a long time.

But injections of hyaluronic acid into the joint, and other periarticular injections have a number of contraindications that the doctor should consider when prescribing such a treatment. They are divided into absolute and relative. The first group includes the following:

• Septic infectious inflammatory processes in both the joint and adjacent tissues. Or, the patient’s diagnosis of a common infectious disease.
• Pathological bleeding. It can be of an endocrine nature, or caused by taking medications - anticoagulants.
• Dry joint. That is, the absence of signs of inflammation in the joint itself. The non-inflammatory nature of the pain syndrome, which can also be noted in the patient.
• Severe bone deformation, joint destruction. In particular, this is a sharp narrowing of the joint spaces, ankylosis. Or joint instability, which may be due to arthritis.
• Aseptic necrosis of the epiphyses of the bones that form the joint, as well as periarticular osteoporosis in a pronounced form, trans-articular fracture of the bones.

For intraarticular injections with arthrosis, there are several relative contraindications:

• Severe condition of the patient.
• Short-term effect or complete inefficiency after the introduction of two such injections.

Procedure

If we analyze the technique of intra-articular injections, we will see that the procedure begins with a thorough preparation:

1. Making the patient a general diagnosis (if this has not been undertaken previously).
2. Assessment of local status - articular and periarticular.
3. Definition of indications for the introduction of such injections.
4. Determination of the absence of contraindications to the local use of glucocorticosteroid drugs.
5. Determining the location where the injection of the drug will be injected.
6. Obligatory informing the patient about the procedure, obtaining written consent from him for its implementation.
7. The choice of drug for treatment in an individual case.
8. Determination of the dosage of the drug.
9. Scheduling procedures and determining their multiplicity.
10. Actually, the procedure.

What drugs are used for an injection in the joint for arthrosis of the knee joint? We list the most common medications and indications for their use.

Medications for pronounced local inflammation

If the patient notes pronounced pain in a particular joint, he may be shown a glucocorticosteroid with prolonged exposure. Medicines are also applicable to patients with chronic rheumatic pathologies.

In particular, periarticular administration of Diprospan (betamethasone) may be prescribed. This drug has the following properties:

• Its composition includes both fast and slowly soluble salts.
• It has both a quick and prolonged effect on the inflamed area. So the patient feels the first effect of the drug within 1-3 hours after the injection. The anti-inflammatory and analgesic effects of "Diprospan" at the same time persists for up to 4-6 weeks.
• It does not cause local fine crystalline reactions.
• It does not have local dystrophic effects on adjacent tissues.

The medicine can be used for both intraarticular and periarticular administration. In particular, it is prescribed for arthritis, bursitis, periarthritis, secondary synovitis and so on.

"Diprospan" is also good because it can be prescribed to patients once, and if appropriate indications are repeated.

The next category of drugs that are used for injections into joints and nearby tissues for local pains is “Trikort”, “Kenalog”. In their regard, it is important to highlight the following:

• The duration of analgesic and anti-inflammatory effects on the tissues reaches 3-6 weeks.
• It is noted that 6-12 hours after the administration of the drug, microcrystalline short-term inflammation of the joints may occur. The doctor must warn the patient about this side effect.
• The medicine is characterized by pronounced local dystrophic effects. It can reach localized atrophy of the skin, tendons or nerve trunks with repeated administration of the drug.
• These funds can only be used for injection in the bursa or joint cavity. This can be indicated for arthritis, bursitis, and synovitis.
• These drugs are not intended for periarticular administration into soft periarticular tissues.
• Doctors do not recommend using Kenalog and Tricort for reintroduction of brushes into joints. This is fraught with the appearance of a cosmetic side effect - skin atrophy. Therefore, in this case, drugs are not prescribed for children and women.

Medications for mild local inflammation

We will analyze what injections into the joint in case of arthrosis of the knee joint can be prescribed if the patient notes not a bright, but a moderate pain syndrome. Metipred will be shown. The tool has the following characteristics:

• It has a moderate analgesic and anti-inflammatory effect. The duration of exposure to the drug is 1.5-2 weeks.
• In certain cases, short-term microcrystalline local inflammation of the joint is noted 1-3 hours after the injection of the drug.
• The drug does not exert local dystrophic effect on nearby tissues.

It is recommended to appoint "Metipred" for both intraarticular and periarticular administration. Suitable for both single and repeated injections. The greatest efficacy of the drug is observed in moderate inflammatory processes (accompanied by the same moderate pain). It is prescribed for various rheumatic conditions, as well as post-traumatic reactions of the body.

Medications for mild local inflammation

Now consider what drugs are used for intra-articular injections into the shoulder joint, knee in the case when the patient notes moderate or weak pain. In particular, this is possible with arthritis, bursitis, secondary synovitis, inflammatory processes in the periarticular tissues. In these cases, use a short-acting drug - hydrocortisone acetate. We list its characteristic features:

• It has a weaker, sparing effect than the above funds.
• The duration of exposure to the drug lasts up to 1-1.5 weeks.
• It can cause local microcrystalline inflammation of the joint for a short period of time, about which the doctor should warn his patient in advance.
• Local dystrophic effect when accessing this drug is not caused.
• It is prescribed for both single and repeated use.

Required dosage

How to make intraarticular injections? After the specialist determines the drug, he must prescribe an individual dosage for the patient. This, first of all, depends on the location where the injection will be administered. The options are as follows:

• Large joints. For example, knee or shoulder. A single dose of the drug is administered. Usually this is the contents of one bottle, ampoule.
• Hip joint. It is important to note that glucocorticosteroid injections should be entered into this location only if there are absolute indications. The procedure is performed in a hospital. It is advisable to entrust it to an experienced specialist.
• Middle joints. These are ulnar, wrist and ankle. As for the dosage, it is permissible to introduce no more than 1/2 of the dose of the drug.
• Small joints. Interphalangeal, plus metatarsophalangeal, metacarpophalangeal are distinguished in the category. No more than 1/4 to 1/5 of the dose of the drug selected by the doctor is administered once.

The treatment regimen and frequency of procedures

As for a single procedure, in this case, it means the introduction of the drug:

• In one large joint.
• In two middle joints.
• In three to five small joints.

The multiplicity is determined by the attending doctor individually for each patient. In particular, the effectiveness of the previous administration of the drug is evaluated, the necessary indications for repeating the procedure are found.

But it should be noted that the administration of glucocorticosteroids by the intraarticular or periarticular method in the form of a course is categorically unacceptable. If after the first injection a short-term or insufficient effect was observed, then repeated administration is possible after 4-5 days. If it turned out to be insufficiently effective, then the introduction of the drug into the joints or periarticular tissues must be completely abandoned.

As for the interval between repeated injections, its most minimal extent depends on the intensity of the effect of the agent used:

• Potent drugs: 1-2 months.
• Medium effective funds: 2-3 weeks.
• Drugs with short-term exposure: 5-7 days.

If these intervals are not observed, then this is fraught with the following negative effects:

• The development and intensification of dystrophic processes occurring in the cartilage or bone.
• The development of aseptic tissue necrosis.

Features of the procedure

The introduction of GCS into the joint or periarticular tissue is carried out only after the preparation for the procedure described above. The specialist should pay attention to the following:

• If the patient has increased psycho-emotional activity, then he is additionally administered subcutaneously "Relanium" before joint injection.
• Injections into the small joints of the limbs are rather painful, which the doctor must warn the patient about.
• If there must be an effusion, then before the introduction of a glucocorticosteroid, the specialist must evacuate the inflammatory fluid there from the joint cavity.
• After the procedure (especially if the injection was made into the load joint), the patient should provide the maximum possible rest of the limb for 3-4 hours.

The injection should only take place in a specially equipped treatment room with an aseptically clean dressing room. Before the procedure, the patient must remove clothing that interferes with manipulation, collect long hair, and remove street shoes before entering the office.

Syringes for intraarticular injections are disposable, sterile. Their capacity is standard - 5, 10, 20 ml. As for the diameter of the needles, two variations are used here: 0.5-16 mm and 0.8-40 mm. Atraumatic disposable needles may also be additionally used.

The doctor must carry out the procedure in disposable medical gloves. After each patient, he carefully processes them with alcohol. Accordingly, the specialist must be familiar with the technique of intraarticular and periarticular administration of corticosteroids. The doctor undergoes appropriate training, his qualifications are confirmed by a certificate.

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