Injections for arthritis
Injections for arthritis can offer pain relief and restore the natural function of joints alongside a holistic physiotherapy treatment.
What is arthritis?
Arthritis is not a single disease – it is more an informal way of describing joint pain or joint disease. There are different types of arthritis with osteoarthritis and rheumatoid arthritis being the most common.
Osteoarthritis (OA) is by far the most prevalent cause of arthritis affecting around 9 million people in the UK. It is often referred to as a ‘wear and tear’ problem because it tends to progress with age with people over the age of 50 most commonly affected. Initially pain is the dominant feature but this can be accompanied by stiffness and swelling which can be resistant to the usual treatments of rest and anti-inflammatory medication. Almost any joint can be affected by OA but the weight-bearing joints are more commonly affected with the knee and hip at the top of the leader board! OA also affects the ankle and the joints of the feet (particularly the big toe joint) and the small joints of the hand (especially the thumb joint).
Rheumatoid arthritis (RA) can also cause pain and inflammation in the joints. RA is termed an autoimmune disease, meaning, your own immune system attacks the lining of the joints called the synovium. Unlike osteoarthritis, RA tends to affect both sides of the body and is prevalent in the hands, fingers, knees and ankles. Rheumatoid arthritis also affects other organs, such as, the eyes, skin and circulatory system. If you suspect that you have RA, it is important that you see your GP who will confirm the diagnosis with some blood tests. They will also prescribe some medication that prevents the immune system from attacking the joints.
Further information about osteoarthritis can be found here. Only a small proportion of patients end up needing joint replacement surgery but it is the hip and knee that are most likely to be be replaced. In the UK around 160,000 hip and knee joint replacements are undertaken each year.
Does physiotherapy help?
Osteoarthritis cannot yet be cured but advances in treatment over the last decade have improved the outcomes considerably. The first line of defence for rheumatoid arthritis is medication but physio is also important to relieve the symptoms.
Physiotherapists are best placed to help manage your condition by:
- addressing lifestyle changes
- advising on pain relief medications
- using hands-on physiotherapy treatment
- giving specific exercises to address weakness and loss of mobility
- injections for arthritis can also be considered
If the joint is acutely painful sometime aquatic therapy is needed where the warmth and bouyancy of the water provides a soothing environment which relieves pain and stiffness but still offers some resistance for muscle-strengthening exercises.
Injections for arthritis
There are a number of injections therapy options available for the treatment or arthritis. Here at The Physios, we strongly advise that injections sit alongside a holistic physiotherapy treatment plan and conditioning exercises.
1. Steroid injections
Steroid injections have been widely used in the treatment of inflammatory conditions affecting the joints including osteo and rheumatoid arthritis. The inflammatory process of arthritis causes pain, swelling and loss of function and is dampened down by the powerful anti-inflammatory effect of the steroids. There is good evidence that shows benefit in the shorter term (often between 3-12 weeks) providing a reduction in pain that allows recovery of movement and strength and a return of function and some people do report longer term benefit but this is by no means a given. It is known that repeated injections of steroid can be harmful to the joint.
2. Hyaluronic acid injections
Hyaluronic acid is a natural constituent found within the joint structure and helps to provide viscosity and elasticity to the joint fluid – important features of a healthy joint. Arthritis adversely affects the normal conditions within the joint and injecting HA helps to restore this, thereby reducing the symptoms associated with the condition. There is increasing evidence to show that its effect can be longer lasting than steroid and that side effects are minimal making this an attractive choice for both clinicians and patient. We use a product called Ostenil here at The Physios, check out their guide to Hyaluronic acid.
3. Combined steroid and hyaluronic acid injections
Combined hyaluronic and steroid injections can be efficacious in cases where the short term benefits of steroid and the longer lasting effects of the hyaluronic acid are needed. This might be an option where the joint is very irritable and inflamed as the steroid is invariably the best way of treating this and the addition of HA helps to ensure that the longer term health of the joint is addressed too.
The good news is that my knee is much improved since the injection three weeks ago. The pain is much reduced, I can move faster and better and even managed to run quite a long way for a bus! Hope this continues as life is much better. Thank you so much for your combined help and hope to see you in a year’s time for another injection to keep me away from the surgeon’s knife…..A recent patient had a combined injection as she had a swollen and irritable knee alongside an ongoing achy knee from previous sporting injury.
So which injection is right for me?
Great question! Everyone is different so that is why we cannot advise on which injection may be right for you until we complete a detailed clinical assessment. From here your physio can arrange anything else you might require, for example, some ‘hands-on’ treatment to restore the movement in your joint, a scan or Xray to confirm the diagnosis or indeed indicate which injection is best for you.