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Injection therapy 

Injection therapy
Injection therapy
Oxford Textbook of Rheumatology (4 ed.)

Philip Platt

and Ismael Atchia

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Joint and soft tissue injections with glucocorticoids and other agents remain a critical aspect of the management of musculoskeletal conditions. Injection therapy has previously consisted mainly of glucocorticoid and local anaesthetic, but other agents such as hyaluronic acid, radioactive agents, plasma-rich products, and biologics have also been introduced in the practice of musculoskeletal clinicians. Overall glucocorticoid injection remains the most widely performed procedure, and is an effective treatment for an inflamed joint or soft tissue. This procedure has been widely used for at least five decades. Hydrocortisone was the initial steroid used but longer-acting steroid agents are now favoured for large joints. There is evidence of efficacy not only for inflammatory arthritis conditions, but also for osteoarthritis. There are certain contraindications for injection therapy. Hyaluronic acid (viscosupplementation) injection has become part of the management of osteoarthritis. More recently other agents such as disease-modifying anti-rheumatic drugs (DMARDs) and biologics have been injected with varying degree of success. The ability to deliver an injection accurately depends on appropriate knowledge of the anatomy and, as for any procedures, the experience and skill of the clinician. The approach to different joints and soft tissue structures is described in this chapter.

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