Cochrane Summaries

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Intra-articular steroids and splints/rest for arthritis in children and adults

Wallen MM, Gillies D
Published Online: 
8 October 2008

Do intra-articular steroid injections work for treating rheumatoid arthritis and should people rest after the injections?
Seven moderate quality studies were reviewed and provide the best evidence we have today. The studies tested 346 adults with rheumatoid arthritis. They compared people who had a steroid injection, a fake injection or aspiration/washout of their knees or wrists to each other. Two studies tested whether people should rest their joints after injections.

What is rheumatoid arthritis and how might steroid injections help?

Rheumatoid arthritis is a disease in which the body's immune system attacks its own healthy tissues. The attack happens mostly in the joints of the hands and feet and causes redness, pain, swelling and heat around the joints. Intra-articular steroid injections into a joint can be used to decrease pain and swelling quickly. People may have steroid injections to delay starting steroid pills or arthritis drugs, or when drugs are not controlling pain enough. It is not clear if steroid injections work and if people should rest their joints after injections.

What did the studies show?

One of two studies show that people who had steroid injections had less pain the first day than people who had fake injections.

Pain decreased by about 15 points on a 0-100 scale with a steroid injection and 7 points with a fake injection.

The change in pain, however, was the same after 1 or 7 to 12 weeks with or without steroid injections.

Studies show that people who had steroid injections could bend and straighten their leg better/farther and had less swelling around their knee than people with fake injections. Morning stiffness also did not last as long with steroid injections. But one study shows that people could walk faster with steroid injections while another study shows they could not.

People had less pain, stiffness, swelling, and could walk faster if they rested their knees after steroid injections to their knees. But after steroid injections to their wrists, people felt the same whether they rested their wrists or not - but more had a relapse when they rested.

How safe are steroid injections?

No side effects due to injections were reported.

What is the bottom line?
The level of quality of the evidence is 'silver'. Intra-articular steroid injections can improve pain, movement, stiffness and swelling and are safe in adults with rheumatoid arthritis. There is no evidence to say whether this is true for children.

Knees should be rested after a steroid injection, but wrists should not.