Rheumatology Question 35 Instructor

Corticosteroids are commonly used for joint injections. When obtaining informed consent for such a procedure, what are the potential side effects that must be discussed with a patient? What are the absolute and relative contraindications to such an injection?

  1. Infection
    (This is quite rare, with an estimated risk of 1/10,000)
  2. Tendon rupture
  3. Post-injection flare
    (an acute arthritis that is likely due to crystallization of the steroid within the joint)
  4. Skin atrophy/depigmentation at site of injection
    (a particular risk in dark-skinned individuals)
  5. Facial flushing which may last one or two days
  6. Temporary worsening of glycemic control in diabetics (lasting days)

Contraindications to corticosteroid injection include:

  1. Infected tissue overlying the injection site
  2. Suspected infection in the joint to be injected
  3. Bacteremia
  4. Prosthetic joints – you should involve orthopedics rather than placing a needle in a prosthetic joint for any reason, as the risk of introducing an infection is much higher than in a native joint.
  5. Patients who are anticoagulated can be aspirated or injected with caution if they are within a therapeutic INR or PTT range.

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