What are the indications for joint injection and aspiration in patients with osteoarthritis?

Indications for joint injection and aspiration in patients with osteoarthritis include:

• Relief of significant joint pain and stiffness when non-surgical management such as therapeutic exercise, weight loss, and oral or topical analgesics are ineffective or unsuitable.
• Management of acute flares characterized by temporary worsening of symptoms including pain, swelling, and stiffness that impact function and quality of life.
• Diagnostic aspiration to exclude other causes of joint symptoms such as infection or crystal arthropathy, especially if there are atypical features like a hot swollen joint or rapid symptom progression.
• Therapeutic aspiration to reduce joint effusion and improve mobility in symptomatic joints.
• Consideration of intra-articular corticosteroid injections for short-term symptom relief in osteoarthritis, particularly in the knee and hip joints, when conservative measures have failed.

Joint injections and aspirations are not routinely recommended as first-line treatments but are reserved for specific clinical scenarios where symptom control is inadequate or diagnostic clarification is needed. Clinical assessment guides the decision rather than imaging or numerical scoring systems. The procedure should be part of a comprehensive management plan including non-pharmacological and pharmacological treatments. Risks and benefits should be discussed with the patient, and injections should be performed by trained clinicians under aseptic conditions to minimize complications ¹ (Cardone and Tallia, 2003) (Webb et al., 2024).