Joint injections

Your doctor may recommend a joint injection to treat your child’s juvenile idiopathic arthritis (JIA). Joint injections are safe, effective and usually work quickly to relieve symptoms (such as pain, swelling and stiffness) within days.

Joint injections are very quick procedures (often faster than a simple blood test) but the effect is usually long-lasting. In most children, the arthritis will not reoccur in the injected joint for many months – often 12 months or longer. In some children, the arthritis never returns.

Will my child need a general anaesthetic for their joint injection?

Joint injections can be given when your child is under general anaesthetic, light sedation or even with just a local anaesthetic or numbing cream. Talk to your child’s doctor and nurses about the right option for your child. This is likely to change with time, as they get older and more confident with doctors and the procedure

General anaesthetic

A general anaesthetic ensures your child is asleep during the joint injection procedure. This is the most suitable option for young children who struggle to stay still or remain calm during procedure involving needles. You can stay with your child until the anaesthetist puts them to sleep and will be called back when your child is waking up again.

Light sedation

The most common light sedation medication is Entonox (laughing gas). Entonox is a mixture of nitrous oxide gas mixed with oxygen. Your child can breathe it in during their joint injection procedure to help them feel relaxed and comfortable. They will breathe in the Entonox using a mouthpiece that looks like a whistle and will be supervised by a specially trained nurse. The gas works quickly and wears off quickly after the procedure, usually within a minute. Additional sedation medication is available on the day if required.

During light sedation, you can stay with your child throughout the procedure, hold their hand, talk to them or play their favourite music/videos. Your child will be awake but will feel more relaxed, experience less pain and may even feel sleepy.

Local anaesthetic or numbing cream

Older children or adolescents may choose to have the joint injection with only numbing cream or a local anaesthetic injected under their skin. Most patients find the procedure to be quicker and less painful than they expected. Once the anaesthetic is working, the injection usually takes less than a minute. If your child is happy to have the procedure under local anaesthetic, it may be possible to give the joint injection at the time of their clinic appointment.

What to expect

Preparing for a joint injection

You will be contacted by the hospital before your child’s appointment to tell you where and when to attend.

• For a general anaesthetic: your child must not eat or drink for at least 6 hours before coming to hospital.
• For a light sedation (Entonox): your child must not eat or drink for at least 2 hours before coming to hospital.
• Numbing cream: this will be applied to the injection site approximately 60 minutes before the procedure.

Your child should wear loose clothing that can be easily pulled up to uncover the affected joints.

Please advise the Rheumatology Team as soon as possible if your child is unwell or has a fever. This will enable the procedure to be rescheduled, if necessary.

On the day

A nurse will check your child’s health including their temperature and blood pressure, and will listen to their heart and lungs. If your child would like to use numbing cream, the nurse or doctor will apply it to the injection site/s. The nurse will explain the procedure to you and your child, answer your questions and confirm the procedure plan you have prepared.

During the procedure, the doctor will insert a needle into the space around the affected joint, remove any fluid that is present, then inject steroid medicine to treat the arthritis.

After the procedure

After the joint injection, your child will stay in hospital until their anaesthetic or light sedation has worn off. They will be discharged home the same day, usually an hour or two after the procedure. They do not need to stay overnight. Your child will have a small stick-on dressing applied to the site of their joint injection/s and this can be removed after 48 hours.

Care at home

Your child should take it easy for the first 24 hours after the joint injection and avoid high-impact activities such as sport or physical education. If a leg joint is injected, it’s safe for them to walk for short distances (e.g. around your house or to the bathroom). Some children will experience discomfort after their procedure and this can be treated with simple pain relief such as paracetamol (Panadol), ibuprofen (Nurofen) or other prescribed anti-inflammatories. An icepack may also be helpful.

Your child may have required the injection because the joint was restricted. Implementing an exercise program afterwards will help them regain more movement.

Keep an eye on your child in the days following the procedure. If they develop very severe pain in the injected joint, or a fever over 38 degrees, they should be urgently reviewed by a doctor to ensure there is no infection. If you cannot see your GP urgently, take your child to your local emergency department.

What are the possible side effects?

Joint injections are generally very safe and well-tolerated. A small number of children may experience some pain after their procedure and this can be treated with simple pain relief or icepacks.

Changes in the skin where the needle was injected and the steroid medication leaks back out of the injection hole are called subcutaneous atrophy. This happens in approximately 1-2 per cent of joint injections and can look like a dimple where the needle entered the skin or sometimes a small area where the skin loses its colour and appears bleached. This is not dangerous and usually improves with time.

Small pieces of calcium may develop within the joint after the injection. This occurs rarely and doesn’t usually cause symptoms or interfere with movement, but the pieces may be visible on an X-ray.

There is a very low risk that an infection can enter the joint at the time of the procedure (approximately 1 in 75,000 injections). Special precautions are taken to prevent this occurring such as cleaning your child’s skin with disinfectant before the injection takes place.

Key points

• Joint injections are safe, effective and, in most patients, work very quickly to relieve symptoms (such as pain, swelling and stiffness) within days.
• During the procedure, the doctor will insert a needle into the space around the affected joint, remove any fluid that is present, then inject steroid medicine to treat the arthritis.
• There is a low risk of infection following this procedure but, if your child develops severe joint pain or a fever (over 38 degrees) they should be urgently reviewed by a doctor.

Developed by the Rheumatology Service, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS213. Reviewed: March 2022.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.