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Joint injections with Entonox sedation

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.

Illustration diagram showing a joint, muscle, tendon, bone, cartilage

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 usually carried out in the Outpatient Department (OPD) or on the Medical Day Care (MDC) unit.

We advise that your child does not have anything to eat or drink for 1 hour before their appointment as the Entonox can very occasionally make them feel sick.

The procedure will be carried out by the rheumatology consultant or doctor, extended scope practitioner (ESP) or physiotherapist, or rheumatology specialist nurse. We will need to ask you and your child some questions as a precaution before they can have Entonox.

After the procedure

Your child will be able to go home once the effects of the Entonox have worn off, this usually only takes a few minutes once the Entonox has stopped being given.

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.


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.

  • Use an ice pack or ice wrapped in a towel to reduce swelling and bruising may help.
  • 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 have a high temperature due to steroid joint injections. Please seek medical advice if your child becomes unwell following joint injections.

Further resources

Please read our resource for more information about risks of anaesthetics.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not 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 this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: RHM14

Resource Type: Article

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Rheumatology Team

Tel: 0114 2717786

e-mail: rheumatology.nurses@nhs.net


Western Bank
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

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