Corticosteroid versus Hyaluronic acid injections – which is best for me?

Hyaluronic acid injections

Hyaluronic acid is a substance already present in our bodies. It is used in joints to help with joint lubrication. It is often referred to as a “viscosupplement” or artificial joint fluid. As a joint becomes arthritic, the quality of the joint fluid diminishes.

Osteoarthritis of joints causes degeneration of the joint surfaces, but there are also changes in the surrounding muscle, joint capsule and joint fluid (Obrien et al. 2019).  It is the changes in the joint fluid that is the primary focus of treatment using Hyaluronic acid. 

Hyaluronic acid is the main viscoelastic constituent of the joint fluid with lubricating and cushioning properties (Raeissadat et al. 2020). Putting Hyaluronic acid back into the joint can help reduce pain through filtering inflammatory molecules and helping lubricate the joint.

Hyaluronic acid is also used to lubricate sites of friction like around a tendon. A tendon suffering from friction may present as “tenosynovitis” which is a painful swelling around a tendon. You can experience a crunching sensation as the tendon slides through the inflamed tendon sheath. This can be common around the achilles tendon and will often benefit from an injection of Hyaluronic acid to help the tendon glide freely again.

The benefits of a Hyaluronic acid injection is that it is not a drug. Therefore there are no interactions with other medications, and no reported long term detrimental effects to the joints. Pain relief can also last between 6- 9 months following an injection. This makes it a very suitable treatment for mild to moderate arthritis (Görmeli et al 2015). There is also no limit to the number of Hyaluronic acid injections you can have, so it is a good choice for chronic conditions like arthritis.

Bellamy et al (2006) found that Hyaluronic acid injections appear to be an effective treatment for arthritis of the knee with beneficial effects on pain and function. They suggest that intra-articular injections of Hyaluronic acid may be more durable than a steroid injection, albeit with a slower response.

What are the down sides of a Hyaluronic acid injection?

It is not a powerful anti inflammatory drug. Therefore if you are in a lot of pain, a Hyaluronic acid injection might not be right for you. However, you can have it as an adjunct to a steroid injection either at the same time or after the pain settles with a steroid injection. So if you have a lot of pain and inflammation, a steroid injection is more likely to give you better relief. In severe arthritis, Hyaluronic acid may not help as there is too much joint deterioration.

Another possible side effect is post injection flare. Like a steroid injection, some patients may experience a flare of pain after the injection. This is because we are injecting more fluid into a confined space and the substance and pressure can aggravate things temporarily. This is managed with painkillers and if required anti inflammatory medications. Most flares only last a day or 2 but some joints may feel uncomfortable for a week or so until the benefits are noticed. 

An injection of Hyaluronic acid can take up to 3 weeks to take effect. Those that do experience relief will notice a peak benefit around 5-13 weeks post injection Bellamy et al (2006).

The benefits of Hyaluronic acid injections are unpredictable. A lot of patients will experience relief but not everyone will respond the same meaning that some people may only experience little or no relief. 

In Summary

Both steroid and Hyaluronic acid injections can give you relief for varying amounts of time. Mild to moderate arthritis may be a good candidate for Hyaluronic acid injections and more painful conditions may be better suited to a steroid injection. The key is understanding what the diagnosis is. Our clinical specialists will assess the condition with diagnostic ultrasound to understand what the pathology is. Once we know what structure is likely to be causing the pain, we can advise on the treatment options for you.

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