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OA - MEDICAL TREATMENTS: INTRA-ARTICULAR INJECTIONS
Intra-articular injections are injections into a joint. They are commonly used for OA treatment in people and horses and their use is increasing in dogs. Studies have shown that more than 70% of dogs have a measurable positive response to the injections.
Intra-articular injections are most useful when one or two joints are significantly affected and less practical, but still possible, when more than two joints are involved.
An appealing and useful feature of intra-articular injections is that they are primarily a local procedure: the injected agent(s) are absorbed very minimally from the joint into the rest of the body.
WHAT IS INJECTED?
The two most common agents we inject intra-articularly are hyaluronate and cortisone. Hyaluronate is a fluid that exists naturally in every living creature. When medical hyaluronate is injected into a joint it lubricates, provides anti-inflammatory effects, slows degeneration, and aids cartilage repair. Cortisone reduces inflammation and thus improves patient comfort. Hyaluronate and cortisone can each be used alone or combined in a single injection.
A third very interesting and potentially very worthwhile agent for intra-articular injections is stem cells. We offer this option at YVC. It is addressed in more detail in a separate OA article and also in its own YVCipedia section.
PROCEDURE AND PROTOCOL
The injections are a relatively simple procedure that we perform under sterile conditions. Patients are awake, sedated, or under general anesthesia, depending on the individual pet.
Veterinarians have not identified one particular schedule for intra-articular injections that can be recommended for all patients. At YVC we believe that beginning with injection(s) of the affected joint(s) once weekly for three weeks is most likely to yield maximum positive results. However, we also feel that injecting once and observing for a response is a reasonable option.
We subsequently use multiple factors to determine when and how often to repeat the injections for individual patients. For example: if we have observed a very good response to the first injection or series of injections we might wait until the pet shows the first signs of the effects wearing off and then repeat the treatment; if we see a poor response at one month after one injection we might try a series of three spaced one week week apart.
Most patients will have some pain and some will experience swelling in the joint(s) for about 12 to 48 hours following the injection(s).
An infected joint is the most significant risk with intra-articular injections. We are careful to use sterile technique when administering the injections, so this risk is very minimal, but it is not completely eliminated.
Some studies in people have demonstrated that repeated intra-articular injections of cortisone over an extended period of time will cause degeneration of the joints; we believe that the relatively small cortisone doses and low frequency of the injections given to dogs make this a very minimal concern.
Peter Smith, DVM
Yarmouth Veterinary Center
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