Ultrasound-guided intra-articular glucocorticoid injection: A systematic review of the literature

Abstract

Ultrasound-guided intra-articular glucocorticoid (IA-GC) injection has transformed local management of various rheumatic diseases by improving procedural accuracy and safety. This systematic review analyzed evidence published between 2010 and 2024 on the efficacy, safety, optimal dosing, and controversies surrounding ultrasound-guided IA-GC, including original articles, systematic reviews, meta-analyses, and clinical practice guidelines. The studies showed that ultrasound guidance significantly increased injection accuracy (86.7% vs 26.7% with landmark guidance; P < .05) and reduced procedural pain by 48% (VAS: 3.0 ± 2.8 cm vs 5.8 ± 3.0 cm; P < .001). It also improved short-term therapeutic outcomes (VAS at 2 weeks: 1.5 ± 1.9 cm vs 2.8 ± 2.4 cm; P = .034), with significant improvements in pain and joint function. In knee osteoarthritis, pain reduction (VAS) was approximately 4.4 points (95% CI: 4.1–4.7), with a short-term success rate of 78.6%. In the acromioclavicular joint, ultrasound guidance yielded greater pain relief (mean difference [MD] 1.9, 95% CI: 1.2–2.6; P < .00001) and functional improvement (Constant score MD 10.9, 95% CI: 6.57–15.23; P < .00001) compared with landmark-guided injection. The most supported regimen was triamcinolone 40 mg for large joints and 10−20 mg for small joints, although dosing varied considerably. Serious complications were uncommon, but systematic safety assessment was insufficient. Ultrasound-guided IA-GC is a valuable tool, although multicenter, standardized studies are needed to strengthen clinical recommendations.