What’s the difference between hyaluronic acid and steroid?
How do I know which to choose between hyaluronic acid and steroid?
Many patients who contact our clinic are unsure as to whether hyaluronic acid or corticosteroid injection would be best for their pain. Both hyaluronic acid and corticosteroid can be used for pain relieving injection into a whole range of peripheral joints, which we perform under ultrasound guidance to ensure accuracy.
In deciding which is likely to be the best treatment, there are a number of different factors that you should take into consideration.
Hyaluronic acid generally works best for osteoarthritis where there is little or no inflammation (swelling). Hyaluronic acid generally works best for people who are active, that have pain in a joint where there is very little swelling (effusion) and they wish to return to activities e.g. running or walking long distances in the example of a knee. The typical example of a patient suitable for hyaluronic acid would be an active 40-50 year old who plays some degree of regular sport or exercise.
Equally, hyaluronic acid can prove a good alternative for people who cannot have steroid injection because they are either allergic to steroid or because they had been advised to avoid steroid injections for medical reasons.
Steroid works best for very quick pain relief. It is a very potent anti-inflammatory and, therefore, is very useful in joints that are inflamed or where there is swelling or effusion. Steroid gives very fast acting pain relief that usually will last for at least a few months. Some patients choose to have hyaluronic acid injected after the steroid, usually around four weeks, to try to prolong the effect of the steroid.
Whilst both injections give pain relief the below points might be useful in helping to decide which would be the most suitable choice
Indications for hyaluronic acid injections
1. Joint pain
2. Little or no inflammation or swelling
3. Patient wishing to remain very active with early osteoarthritis
Indications for steroid injections
1. Acute pain relief.
2. Evidence of swelling or inflammation.
If you would require any further information about either hyaluronic acid or corticosteroid injections, please do not hesitate to email us on injections@complete-physio.co.uk, or call one of our team on 0207–482-3875, where we would be happy to give you information and advice. There are also downloadable information leaflets available on our website (https://complete-physio.co.uk). You do not require a doctor or consultants referral for either injection. We will carry out a medical screening as well as a physical assessment and ultrasound scan assessment on the day to ensure suitability of injection selection.
Research Articles of Interest
Bannuru, R.R., Natov, N.S., Obadan, I.E., Price, L.L., Schmid, C.H. and McAlindon, T.E., 2009. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta‐analysis. Arthritis Care & Research, 61(12), pp.1704-1711.
Jones, A.C., Pattrick, M., Doherty, S. and Doherty, M., 1995. Intra-articular hyaluronic acid compared to intra-articular triamcinolone hexacetonide in inflammatory knee osteoarthritis. Osteoarthritis and Cartilage, 3(4), pp.269-273.
Smith, C., Patel, R., Vannabouathong, C., Sales, B., Rabinovich, A., McCormack, R., Belzile, E.L. and Bhandari, M., 2019. Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 27(6), pp.1974-1983.