Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.
PM R. 2012 May;4(5 Suppl):S75-81. doi: 10.1016/j.pmrj.2012.02.010.
Osteoarthritis is one of the most frequent and chronic conditions that affect the U.S. population. Use of intra-articular injections is one of the established treatment options available in the nonoperative care for the management of symptomatic osteoarthritis. Common injectable medications include corticosteroids, hyaluronic acid, and other less traditional compounds (for example, botulinum toxin). Corticosteroids work by anti-inflammatory and antinociceptive actions. Corticosteroids have been shown to decrease pain and symptoms associated with osteoarthritis for up to 3 weeks. Hyaluronic acid has an unclear mechanism of action, but it is thought to promote the restoration of hyaluronic acid within an osteoarthritic joint. The efficacy of hyaluronic acid is modest and is most beneficial between 5 and 13 weeks after treatment. Other injectable compounds have been studied and include botulinum toxin type A, which has been theorized to work as an antinociceptive agent. One must be aware of the potential adverse effects associated with these medications. For all of these injectable treatments, the placebo effect must not be overlooked, because it has be demonstrated in multiple studies that these medications provide similar relief of pain when compared with placebo. Image guidance with ultrasound or fluoroscopy may be considered when performing intra-articular injections to improve accurate placement of medication.
骨关节炎是影响美国人群的最常见和慢性疾病之一。关节内注射是在非手术治疗管理症状性骨关节炎中可用的既定治疗选择之一。常用的可注射药物包括皮质类固醇、透明质酸和其他不太传统的化合物（例如，肉毒杆菌毒素）。皮质类固醇通过抗炎和镇痛作用发挥作用。皮质类固醇已被证明可在长达 3 周内减轻与骨关节炎相关的疼痛和症状。透明质酸的作用机制尚不清楚，但据认为它可以促进骨关节炎关节内透明质酸的恢复。透明质酸的疗效适度，在治疗后 5 至 13 周之间最有益。已经研究了其他可注射化合物，包括肉毒杆菌毒素 A，据推测它作为一种镇痛剂发挥作用。必须注意这些药物相关的潜在不良反应。对于所有这些可注射治疗，都不能忽视安慰剂效应，因为多项研究已经证明，与安慰剂相比，这些药物在缓解疼痛方面提供了类似的效果。在进行关节内注射时，可以考虑使用超声或透视图像引导，以提高药物的准确位置。
