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Joint injections under general anaesthetic

What is a joint injection?

A joint injection is a common way to treat juvenile idiopathic arthritis (JIA).

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.

A diagram showing a typically normal joint

How long will the effects last for?

Most children notice that the joint is a lot less sore and inflamed within a few days after the injection. The amount of improvement and how long it lasts varies from child to child, and depends on the type of arthritis they have. For the majority of children the improvement lasts for weeks or months.

In some cases the arthritis in that joint goes into remission for years or even for ever. Only a small number of children do not respond to this treatment at all.

What happens on the day of the procedure?

The procedure is carried out in theatre, but your child will be admitted to the Theatre Admissions Unit (TAU).

On the day you will be seen by the TAU staff, the anaesthetist and the consultant or extended scope practitioner (ESP) who will be carrying out the procedure. The consultant will get your written consent before you come for the procedure, or when you are admitted and all joints to be injected will be marked with permanent marker.

After the procedure

Your child will usually be able to go home a couple of hours after they have returned to TAU providing they have had some food and drink.

For 24 hours after the injection your child should avoid using the joint too much. This may mean resting, depending on which joints have been injected.

After this your child should be able to go back to school and resume their usual activities, including taking part in P.E. However, we advise you to make sure that this is a gradual return, especially if a joint has not been used much recently as muscles can ache with a sudden return to activity.

It may be helpful for your child to see the physiotherapist 4 to 6 weeks after the injections. If your child’s rheumatologist feels that this would be appropriate they will liaise with the team physiotherapist to arrange this.

Are there any side effects from the joint injections?

There are a few possible side effects from a joint injection but these are not usually serious. They include:

Skin changes at the injection site

These are called ‘subcutaneous fat atrophy’. 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

This can occur but is very rare. Special precautions are taken to avoid this such as cleaning the skin carefully before giving the injection.

Pain

A small number of children can experience pain in the joints after the injection, but this should settle in a couple of days.

At first, the pain can actually be worse than before the injection as it can take a while for the steroid to start working. This is due to inflammation caused by the injection itself and may last for a day or two.

Do
  • Use an ice pack or ice wrapped in a towel to reduce swelling and bruising may help.
Don't
  • Apply ice directly to the skin.

If you need pain relief, you can give over-the-counter painkillers such as paracetamol or ibuprofen. It may be helpful to give these regularly for the first day or two if needed. Always read the information that comes with your medicine and if you have any questions, ask the rheumatology team for advice.

What about follow up?

If you have any concerns about your child after the joint injections then please do contact the Rheumatology Nurses (0114 271 7786), or your GP for further advice.

Your child should not be unwell or develop a temperature due to steroid joint injections. Please seek medical advice if your child becomes unwell following joint injections.

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

Resource number: RHM13

Resource Type: Article

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Rheumatology Team

Tel: 0114 2717786

e-mail: rheumatology.nurses@nhs.net

NHS

Western Bank
Sheffield
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

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