What is a joint injection?
A joint injection is a treatment that is used for Juvenile Idiopathic Arthritis (J.I.A). It means that your doctor / clinical nurse specialist will insert a small needle into the joint space (the space between the bones in a joint) and inject medicine. This may be done with you awake using laughing gas (Entonox). Most young people notice that the joint is a lot less sore and swollen within a few days of the injection. Injections can make joints feel better for weeks, months or even longer.
Why do I need a joint injection?
Joint injections reduce inflammation and pain in swollen joints. If you have only one or a few joints swollen, they may be the only treatment you need, with occasional repeated injections. If you are taking other medicines already and still have swollen joints, joint injections may save having to increase the doses or introduce new on
What will happen when I get a joint injection?
What is Laughing Gas?
Laughing Gas (Entonox) is a gas that you breath in during the injection. It makes you feel the injection much less and helps you feel relaxed. The nurse will help you practice breathing through the mouth piece that is connected to a tube before and help you during the injection
What is injected into the joint?
A long lasting steroid, which stays in the joint space for over 1 week. Sometimes, a local anaesthetic is also added to the steroid medicine.
Back to topDuring the joint injection
- Your parents can stay with you the whole time to help you feel safe and take your mind off the injection.
- You will go into a room with a bed and some equipment. A nurse will be there to check you are ok.
- You start breathing the laughing gas and in 1 – 2 minutes, it will start to take effect. The doctor and nurse usually know when it is working as you look sleepy or start giggling.
- The doctor or clinical nurse specialist will clean the skin around the joint with an alcohol swab or spray. This can be quite cold.
- A needle attached to a syringe is inserted into the joint. You might feel some discomfort but the laughing gas should stop the needle feeling sharp. Deep breathing at this point will help.
- The doctor or clinical nurse specialist will sometimes pull some fluid from the joint into the syringe. The fluid is yellow. Sometimes, there is a bit of blood mixed in. This is normal.
- Without taking the needle out, the doctor or clinical nurse specialist will take off the syringe with the fluid in it and connect another syringe with medicine in it. The medicine is injected into the joint.
- The needle is then taken out and a small plaster put on. The whole injection takes about 5 minutes.
- If you need more than one joint injection, the doctor or clinical nurse specialist will do it straightaway while you are still relaxed and breathing in the gas
After the injection:
- The laughing gas can make your mouth feel dry. Some people feel a little sick but when you stop breathing the laughing gas, it goes out of your system very quickly and you should start feeling better. A drink soon after can help. As soon as you feel well enough, you can go home, usually around 15 minutes later.
- For 24 hours after the injection, you need to avoid using the joint too much, which may involve resting, depending on which joint(s) is / are involved.
- After this, you should be able to go back to school and resume normal activities such as taking part in P.E. etc. If a joint has not been used much recently, muscles can ache if you suddenly return to full activity so a gradual return is sensible.
- If your joints have become stiff or the surrounding muscles have become weak, you may need to meet with a physiotherapist within a couple of weeks of the joint injection. Your doctor will let you know if this is advised and will arrange it
Are there any side-effects of Steroid Joint Injections?
There are a few possible side-effects from a joint injection but these are not serious.
The injected joint/s can ache for a day or two. This should settle.
Steroid can thin the fat tissue under the skin causing a little dimple or make the overlying skin go a little pink. This is rare and is mainly seen at wrists, ankles and fingers. If it does happen, it doesn’t hurt and doesn’t cause any problem apart from the appearance. It heals with time but this can take several months.
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 injections. Signs of infection is redness and swelling of joint, feeling unwell and a high temperature
If you are worried about pain or how the joint looks afterwards, please ring us or see your GP
How is JIA treated?
Your treatment is planned just for you – it may be different for another person. This is because JIA affects each young person differently.
The main ways of treating JIA include:
- medications to control inflammation;
- steroid joint injections to reduce inflammation, in particular joints;
- exercises to keep joints moving well and muscles strong; and
- pain management strategies to reduce pain and help you cope with pain.
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)
