An intra-articular injection is a type of shot that’s placed directly into ajointto relieve pain.Corticosteroids(steroids), local anesthetics,hyaluronic acid, andBotoxare the most common substances injected into joints for this treatment.
Your healthcare provider might discuss a joint injection with you if your pain has not improved with conservative treatments, such as pain relievers, oralanti-inflammatory drugs, and physical therapy.
This photo contains content that some people may find graphic or disturbing.See PhotoGARO / PHANIE / Getty Images
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
GARO / PHANIE / Getty Images
Types of Intra-Articular Injections
They may also be an effective means of eradicating a fungal infection in joints (also known as fungal arthritis).
When used for alleviating pain, different intra-articular therapies work in different ways. These pain relievers include:
Corticosteroids
Intra-articular injection of corticosteroids for osteoarthritis of the hip and knee has earned a strong recommendation from the American College of Rheumatology, and a conditional recommendation for osteoarthritis of the hand. Long-term use of corticosteroids has been thought to progressively damage the joints, but this is controversial.
Corticosteroid shots are typically administered no less than three months apart. The duration of relief can vary based on the type of steroid used.
Hyaluronic Acid
Hyaluronic acid is a naturally occurring substance found in synovial fluids that lubricate the joints. With osteoarthritis, this substance can rapidly break down and lead to a worsening of the condition. Intra-articular injections have been used to increase lubrication, reduce pain, and improve therange of motionin a joint.
Hyaluronic acid injections are generally administered as a series of shots scheduled over three to five weeks.They are mainly used to buy time beforeknee replacement surgeryin people who are unable to tolerate steroids and have not found relief from oral medications.
Local Anesthetics
Botulinum Toxin
Botox (botulinum neurotoxin A) injections may offer safe and effective pain relief in painful knee osteoarthritis, but more study is needed.Currently, the American College of Rheumatology conditionally recommends against Botox injections for osteoarthritis of the hip and knee.
Botox treatment effects can last as long as 12 weeks in some people and as short as four weeks in others.
Platelet-Rich Plasma
Platelet-rich plasma (PRP) is derived from whole blood and contains platelets (a type of blood cell that is essential for clotting) and the liquid portion of blood known as plasma.
Although intra-articular injections ofPRPhave been shown to reduce pain and improve physical function for some people,their effectiveness in osteoarthritis is controversial. The American College of Rheumatology strongly recommends against the use of PRP in knee and hip osteoarthritis.
The effectiveness of PRP is controversial, though there is some evidence that injections can help reduce pain and improve function.Treatment benefits have been reported to last anywhere from six to nine months.
Side Effects
The two main side effects associated with intra-articular injections are infections and local site reactions. Other side effects can occur in relation to the specific drugs or substances injected.
Corticosteroid Injections
Short-term complications of intra-articular corticosteroid injections are rare and include septic arthritis, injection site pain, skin pigmentation, and atrophy. Corticosteroid injects were found to have minimal systemic effects.
Side effects of intra-articular hyaluronic acid injections include muscle pain and stiffness, difficulty moving, joint pain, and swelling or redness in the joint. Other less serious side effects include bleeding, blistering, discoloration of the skin, itching, numbness, tingling, and tenderness.
In addition to injection site reactions, intra-articular injections of local anesthetics, such as lidocaine, bupivacaine, and ropivacaine, have the potential to damage cartilage, according to research, and should be used with caution.
Botox
Intra-articular Botox injections have very few side effects. Injection site reactions are the most common side effect and may include redness or bruising. Allergic reactions to botox, though rare, are possible and can include anaphylaxis.
Side effects of intra-articular injections of PRP are mild and include temporary joint pain and stiffness, injection site pain, bruising, itching, and tingling sensations in the joint. Side effects typically resolve within 48 hours.
A Word From Verywell
Frequently Asked QuestionsIntra-articular injections are given directly into the joint. Intra-articular injections are most commonly used to treat osteoarthritis in the hip or knee, but they can also be given in other joints, including shoulders, wrists, ankles, hands, and fingers.Intra-articular injections can be painful. In some cases, your healthcare provider may numb the area with a local anesthetic prior to performing the injection. Pain from an intra-articular injection occurs during the procedure and may linger for a few hours after treatment.
Frequently Asked Questions
Intra-articular injections are given directly into the joint. Intra-articular injections are most commonly used to treat osteoarthritis in the hip or knee, but they can also be given in other joints, including shoulders, wrists, ankles, hands, and fingers.
Intra-articular injections can be painful. In some cases, your healthcare provider may numb the area with a local anesthetic prior to performing the injection. Pain from an intra-articular injection occurs during the procedure and may linger for a few hours after treatment.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ayhan E, Kesmezacar H, Akgun I.Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.World J Orthop. 2014;5(3):351–361. doi:10.5312/wjo.v5.i3.351Evans CH, Kraus VB, Setton LA.Progress in intra-articular therapy.Nat Rev Rheumatol. 2014;10(1):11–22. doi:10.1038/nrrheum.2013.159Foster ZJ, Voss TT, Hatch J, Frimodig A.Corticosteroid injections for common musculoskeletal conditions.Am Fam Physician. 2015;92(8):694–699.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/art.41142Arthritis Foundation.Hyaluronic acid injections for osteoarthritis pain.Farkas B, Kvell K, Czömpöly T, Illés T, Bárdos T.Increased chondrocyte death after steroid and local anesthetic combination.Clin Orthop Relat Res. 2010;468(11):3112–3120. doi:10.1007/s11999-010-1443-0Zhai S, Huang B, Yu K.The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis.J Int Med Res.2020 48(4): 0300060519895868. doi:10.1177/0300060519895868Laudy ABM, Bakker EWP, Rekers M, Moen MH.Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis.Br J Sports Med. 2015;49(10):657-672. doi.org/10.1136/bjsports-2014-094036Shahid M, Kundra R.Platelet-rich plasma (PRP) for knee disorders.EFORT Open Rev. 2017;2(1):28–34. doi:10.1302/2058-5241.2.160004Kijowski R.Risks and benefits of intra-articular corticosteroid injection for treatment of osteoarthritis: what radiologists and patients need to know.Radiology. 2019;293(3):664–5. doi:10.1148/radiol.2019192034Mayo Clinic.Hyaluronic acid (injection route).Piper SL, Kramer JD, Kim HT, Feeley BT.Effects of local anesthetics on articular cartilage.Am J Sports Med. 2011;39(10):2245–53. doi:10.1177/0363546511402780Hsieh LF, Wu CW, Chou CC, Yang SW, Wu SH, Lin YJ, Hsu WC.Effects of botulinum toxin Landmark-guided intra-articular injection in subjects with knee osteoarthritis.PM R. 2016;8(12):1127–35. doi:10.1016/j.pmrj.2016.05.009Taniguchi Y, Yoshioka T, Kanamori A, Aoto K, Sugaya H, Yamazaki M.Intra-articular platelet-rich plasma (PRP) injections for treating knee pain associated with osteoarthritis of the knee in the Japanese population: a phase I and IIa clinical trial.Nagoya J Med Sci. 2018;80(1):39-51. doi:10.18999/nagjms.80.1.39
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ayhan E, Kesmezacar H, Akgun I.Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.World J Orthop. 2014;5(3):351–361. doi:10.5312/wjo.v5.i3.351Evans CH, Kraus VB, Setton LA.Progress in intra-articular therapy.Nat Rev Rheumatol. 2014;10(1):11–22. doi:10.1038/nrrheum.2013.159Foster ZJ, Voss TT, Hatch J, Frimodig A.Corticosteroid injections for common musculoskeletal conditions.Am Fam Physician. 2015;92(8):694–699.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/art.41142Arthritis Foundation.Hyaluronic acid injections for osteoarthritis pain.Farkas B, Kvell K, Czömpöly T, Illés T, Bárdos T.Increased chondrocyte death after steroid and local anesthetic combination.Clin Orthop Relat Res. 2010;468(11):3112–3120. doi:10.1007/s11999-010-1443-0Zhai S, Huang B, Yu K.The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis.J Int Med Res.2020 48(4): 0300060519895868. doi:10.1177/0300060519895868Laudy ABM, Bakker EWP, Rekers M, Moen MH.Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis.Br J Sports Med. 2015;49(10):657-672. doi.org/10.1136/bjsports-2014-094036Shahid M, Kundra R.Platelet-rich plasma (PRP) for knee disorders.EFORT Open Rev. 2017;2(1):28–34. doi:10.1302/2058-5241.2.160004Kijowski R.Risks and benefits of intra-articular corticosteroid injection for treatment of osteoarthritis: what radiologists and patients need to know.Radiology. 2019;293(3):664–5. doi:10.1148/radiol.2019192034Mayo Clinic.Hyaluronic acid (injection route).Piper SL, Kramer JD, Kim HT, Feeley BT.Effects of local anesthetics on articular cartilage.Am J Sports Med. 2011;39(10):2245–53. doi:10.1177/0363546511402780Hsieh LF, Wu CW, Chou CC, Yang SW, Wu SH, Lin YJ, Hsu WC.Effects of botulinum toxin Landmark-guided intra-articular injection in subjects with knee osteoarthritis.PM R. 2016;8(12):1127–35. doi:10.1016/j.pmrj.2016.05.009Taniguchi Y, Yoshioka T, Kanamori A, Aoto K, Sugaya H, Yamazaki M.Intra-articular platelet-rich plasma (PRP) injections for treating knee pain associated with osteoarthritis of the knee in the Japanese population: a phase I and IIa clinical trial.Nagoya J Med Sci. 2018;80(1):39-51. doi:10.18999/nagjms.80.1.39
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ayhan E, Kesmezacar H, Akgun I.Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.World J Orthop. 2014;5(3):351–361. doi:10.5312/wjo.v5.i3.351Evans CH, Kraus VB, Setton LA.Progress in intra-articular therapy.Nat Rev Rheumatol. 2014;10(1):11–22. doi:10.1038/nrrheum.2013.159Foster ZJ, Voss TT, Hatch J, Frimodig A.Corticosteroid injections for common musculoskeletal conditions.Am Fam Physician. 2015;92(8):694–699.Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/art.41142Arthritis Foundation.Hyaluronic acid injections for osteoarthritis pain.Farkas B, Kvell K, Czömpöly T, Illés T, Bárdos T.Increased chondrocyte death after steroid and local anesthetic combination.Clin Orthop Relat Res. 2010;468(11):3112–3120. doi:10.1007/s11999-010-1443-0Zhai S, Huang B, Yu K.The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis.J Int Med Res.2020 48(4): 0300060519895868. doi:10.1177/0300060519895868Laudy ABM, Bakker EWP, Rekers M, Moen MH.Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis.Br J Sports Med. 2015;49(10):657-672. doi.org/10.1136/bjsports-2014-094036Shahid M, Kundra R.Platelet-rich plasma (PRP) for knee disorders.EFORT Open Rev. 2017;2(1):28–34. doi:10.1302/2058-5241.2.160004Kijowski R.Risks and benefits of intra-articular corticosteroid injection for treatment of osteoarthritis: what radiologists and patients need to know.Radiology. 2019;293(3):664–5. doi:10.1148/radiol.2019192034Mayo Clinic.Hyaluronic acid (injection route).Piper SL, Kramer JD, Kim HT, Feeley BT.Effects of local anesthetics on articular cartilage.Am J Sports Med. 2011;39(10):2245–53. doi:10.1177/0363546511402780Hsieh LF, Wu CW, Chou CC, Yang SW, Wu SH, Lin YJ, Hsu WC.Effects of botulinum toxin Landmark-guided intra-articular injection in subjects with knee osteoarthritis.PM R. 2016;8(12):1127–35. doi:10.1016/j.pmrj.2016.05.009Taniguchi Y, Yoshioka T, Kanamori A, Aoto K, Sugaya H, Yamazaki M.Intra-articular platelet-rich plasma (PRP) injections for treating knee pain associated with osteoarthritis of the knee in the Japanese population: a phase I and IIa clinical trial.Nagoya J Med Sci. 2018;80(1):39-51. doi:10.18999/nagjms.80.1.39
Ayhan E, Kesmezacar H, Akgun I.Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.World J Orthop. 2014;5(3):351–361. doi:10.5312/wjo.v5.i3.351
Evans CH, Kraus VB, Setton LA.Progress in intra-articular therapy.Nat Rev Rheumatol. 2014;10(1):11–22. doi:10.1038/nrrheum.2013.159
Foster ZJ, Voss TT, Hatch J, Frimodig A.Corticosteroid injections for common musculoskeletal conditions.Am Fam Physician. 2015;92(8):694–699.
Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/art.41142
Arthritis Foundation.Hyaluronic acid injections for osteoarthritis pain.
Farkas B, Kvell K, Czömpöly T, Illés T, Bárdos T.Increased chondrocyte death after steroid and local anesthetic combination.Clin Orthop Relat Res. 2010;468(11):3112–3120. doi:10.1007/s11999-010-1443-0
Zhai S, Huang B, Yu K.The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis.J Int Med Res.2020 48(4): 0300060519895868. doi:10.1177/0300060519895868
Laudy ABM, Bakker EWP, Rekers M, Moen MH.Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis.Br J Sports Med. 2015;49(10):657-672. doi.org/10.1136/bjsports-2014-094036
Shahid M, Kundra R.Platelet-rich plasma (PRP) for knee disorders.EFORT Open Rev. 2017;2(1):28–34. doi:10.1302/2058-5241.2.160004
Kijowski R.Risks and benefits of intra-articular corticosteroid injection for treatment of osteoarthritis: what radiologists and patients need to know.Radiology. 2019;293(3):664–5. doi:10.1148/radiol.2019192034
Mayo Clinic.Hyaluronic acid (injection route).
Piper SL, Kramer JD, Kim HT, Feeley BT.Effects of local anesthetics on articular cartilage.Am J Sports Med. 2011;39(10):2245–53. doi:10.1177/0363546511402780
Hsieh LF, Wu CW, Chou CC, Yang SW, Wu SH, Lin YJ, Hsu WC.Effects of botulinum toxin Landmark-guided intra-articular injection in subjects with knee osteoarthritis.PM R. 2016;8(12):1127–35. doi:10.1016/j.pmrj.2016.05.009
Taniguchi Y, Yoshioka T, Kanamori A, Aoto K, Sugaya H, Yamazaki M.Intra-articular platelet-rich plasma (PRP) injections for treating knee pain associated with osteoarthritis of the knee in the Japanese population: a phase I and IIa clinical trial.Nagoya J Med Sci. 2018;80(1):39-51. doi:10.18999/nagjms.80.1.39
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