Following aspiration of the prepatellar bursa, a pressure dressing should be applied, and the patient should remain in the supine position for several minutes. Following injection, the joint or injected region may be put through passive range of motion. The patient should remain in the office for 30 minutes after the injection to monitor for any adverse reactions. In general, patients should avoid strenuous activity involving the injected region for several days. Patients should be cautioned that they may experience worsening symptoms during the first 24 to 48 hours related to a possible steroid flare, which can be treated with ice and nonsteroidal anti-inflammatory drugs. Patients should be instructed against the application of heat. A follow-up appointment should be scheduled within three weeks.
Timothy E. McAlindon, ., ., of Tufts Medical Center, Boston, and colleagues randomly assigned 140 patients with symptomatic knee osteoarthritis with features of synovitis to injections in the joint with the corticosteroid triamcinolone (n = 70) or saline (n = 70) every 12 weeks for two years. The researchers found that injections with triamcinolone resulted in significantly greater cartilage volume loss than did saline (average change in cartilage thickness of - mm vs - mm) and no significant difference on measures of pain. The saline group had three treatment-related adverse events compared with five in the triamcinolone group.