This information contained aims to answer questions and help parents understand why their child needs a joint injection. It also explains the effectiveness and possible side-effects of treatment, and the practicalities on the day.
What is a Joint Injection?
A joint injection is a common way to treat Juvenile Idiopathic Arthritis. Joint injections reduce inflammation and pain in swollen joints. Your child’s rheumatologist will insert a needle into the joint space (the space between the bones in a joint) and then inject a long-acting steroid medicine into the joint. Most children notice that the joint is a lot less sore and inflamed within a few days after the injection.
How long will the effects last for?
The amount of improvement and how long it lasts varies from child to child and depends on the type of arthritis they have. Most children will notice improvement for weeks or months. Sometimes, the arthritis in that joint goes into remission for years or even, forever. Only a very small number of children do not respond to this treatment at all.
Back to topWhat preparations are needed for the procedure under a general anaesthetic?
- Your child will need to fast in preparation for this procedure, instructions for which will be on your appointment letter. It is very important to follow this; otherwise, the procedure could be cancelled.
- Your child should wear loose clothes that they can pull up to uncover the joints that need to be injected.
- If your child is unwell from 3 days before admission including the morning of admission, please ring the Rheumatology nurses or Children’s Day Care Ward the working day before the procedure (if possible) because it may have to be postponed until they are well.
- Usual morning medications should be taken with the light breakfast.
- Please avoid vaccines for 48 hours before admission. Immunisations can be given at any time after the joint injections.
- Please bring any splints (if you have any) for the joints, which are to be injected.
- You should make arrangements for the child / young person to be driven home afterwards and NOT TAKE PUBLIC TRANSPORT home in view of the general anaesthetic.
- If you cannot attend for any reason, please let us know as early as possible so we can rearrange and use the slot for someone else.
What happens on the day of the procedure?
- The procedure is carried out in theatre but your child will be admitted to the Children’s Ward at the hospital at 12 noon on the date you have been given. Your invite letter may ask you to go to clinic before the Day Unit. One of the nurses will ask you some questions about your child’s health and take your child’s temperature and blood pressure. She / he will also apply some local anaesthetic cream (numbing cream) to your child’s arm or hand to allow the anaesthetist to insert a cannula (a little plastic straw for anaesthetic medicines and fluids) when your child gets to theatre.
- The anaesthetist will visit your child on the ward before the procedure to take a medical history and your child’s joints will be examined again by one of the Rheumatology doctors or nurses who will perform the joint injections. Exactly which joint(s) will be injected will be discussed and written consent sought on a standard form.
- When it is time for your child to have their joints injected, one parent can go with them to the theatre until they are asleep, then wait in an area close by.
- Your child will need to breathe an anaesthetic gas that will keep them asleep for the procedure. They will be unaware of the procedure.
How can I help my child cope with the procedure?
Some children and parents can be very nervous about an upcoming joint injection, this is a normal response. Being informed about a procedure can reduce the anxiety you may feel and help you deal with your own fears or concerns. Being able to talk to your child about what they may expect and about specific fears, they may have can help them cope with the procedure. Because you can go with your child to the theatre where they will be having the joint injection, you can play a big role in helping your child relax.
After the Injection(s)
- The general anaesthetic can make your child’s mouth feel dry. Some children feel a little sick, whilst others are sleepy for a while.
- Juice and water is available on the ward for your child to drink when they are fully awake after the procedure. Once your child has fully recovered from the anesthetic, has had something to drink and has passed urine, they will be ready to go home with you. Usually around 2 hours after theatre, they will be ready to go home.
- For 24 hours after the injection, your child should avoid using the joint too much. This may involve resting, depending on which joint have been injected.
- After this, your child should be able to go back to school and resume normal activities such as taking part in P.E. etc; however, a gradual return is sensible, especially if a joint has not been used much recently as muscles can ache with a sudden return to activity.
- If the joint(s) have become stiff or the surrounding muscles have become weak, then meeting with the physiotherapist within a couple of weeks of the joint injection is advised. The doctor who saw you in clinic or who performs the joint injection will advise you if this is needed and will arrange it.
Are there any side-effects of the joint injection(s)?
There are a few possible side-effects from a joint injection but these are usually not serious.
These include:
Skin changes at the site of the injection called subcutaneous fat atrophy. This appears as a dimple or indentation at the point where the needle went in. These skin changes usually recover over time and don’t cause any pain. Occasionally, the same area can lose some normal skin colour;
Infection of the joint is a potential risk but is very unlikely and happens very rarely. Special precautions are taken to avoid this such as cleaning the skin carefully before injecting. Signs of infection are redness and swelling of the joint, feeling unwell and a high temperature; and
A small proportion of children can experience an ache in the joints after the injection but this should settle in a day or two.
Contact details
Please feel free to contact the Paediatric Rheumatology Nurses on:
Paediatric Rheumatology Nurses
(answer phone if we are not around to answer or use the email address below)
