Intra-Articular (IA) injections are common place in human and equine medicine, whether being used for diagnostic or therapeutic procedures.
Why is this? Historically, IA injections weren’t a common procedure for OA treatment due to a lack of products available for small animal species and there was an educational void surrounding the use of those products. Additionally, there is a decreased comfort level in performing IA injections in smaller animals since the joint spaces are much smaller than that of the large hooved patients and the procedure is not as common place.
In today’s blog, we will discuss the uses of intra-articular Injections, products that are commonly used for IA treatments and educational opportunities that can equip the small animal practitioner with the skills necessary to perform these procedures.
Intra-articular injections can be used in a multi-modal approach for treating osteoarthritis or can be used for a variety of other indications including:
- Patients with residual post-operative intra-articular symptoms (effusion, discomfort, lameness)
- Supplementation/ alternative treatment to oral meds
- Post-surgical lavage
- Arthrocentesis for differentiating OA from inflammatory joint diseases
- Joint blocking for lameness workups
Which products are commonly used in IA injections?
- Regenerative Medicine Products
As discussed in our previous posts, regenerative medicine, which includes Platelet Rich Plasma (PRP) and Stem Cell therapies, utilizes the body’s own cells to heal and regenerate tissue. With minimal side-effects and treatment benefits lasting upwards of 9-12 months, regenerative medicine treatments are ideal for patients with mild to moderate osteoarthritis.
- Hyaluronic Acid (HA)
Hyaluronic Acid is a naturally occurring polysaccharide in the extracellular matrix of the body. HA has been synthetically manufactured for the treatment of OA in dogs, horses and humans. When injected, HA binds to receptors on the chondrocytes which induces cellular proliferation and extracellular matrix production. Typical treatment schedules require a series of loading phase (weekly administration) injections and re-administration every 3-6 months. Efficacy of HA injections varies depending on the molecular weight of the HA and can adversely affect tissue if injected outside of the joint capsule.
- Corticosteroids
Commonly used in human medicine, intra-articular injections of corticosteroids are recommended in several guidelines for the treatment of patients with OA but remain controversial. Corticosteroids prevent the formation of prostaglandins and are a powerful modulator of inflammatory pathways. However, it is not recommended for long term use (no more than 4 administrations/ year total) and can have negative side effects to the cartilage in the joint.
Now that we know what intra-articular injections can be used for and what can be administered using them, we’re ready to inject, right? For some that may be the next step. But for most of us, IA injections can seem daunting, especially if we’ve never done one before (or perhaps haven’t done them since the equine rotation back in vet school). The good news is that now there is a wealth of educational resources available to gain proficiency at IA injections, including the Companion Regenerative University events. Companion Regenerative University is a one-day live seminar where attendees learn the background to regenerative medicine and get the hands-on practice of performing intra-articular injections. To learn more about this course or to see when and where upcoming courses are taking place, click here.
Stay tuned for our next post where we will take a closer look at a case study involving a patient with a Fibrocartilaginous Embolism who got his step back thanks to regenerative medicine.