Table 1

Overarching principles and recommendations, with agreement and level of evidence and grade of recommendation (if applicable)

Overarching principlesA (%)
I. IAT are recommended and widely used in the management of joint diseases.98
II.The aim of IAT is to improve patient-centred outcomes.100
III.Contextual factors are important and contribute to the effect of IAT.93
IV.IAT should be offered in the frame of full individualised information and a shared decision-making process.97
V. A variety of health professionals perform these procedures routinely.94
RecommendationsA (%)LEGR
1.The patient must be fully informed of the nature of the procedure, the injectable, and potential benefits and risks; informed consent should be obtained and documented according to local habits.994D
  1. An optimal setting for IAT includes:

  • Professional, clean, quiet, private, well-lightened room.

  • Patient in an appropriate position, ideally on a couch/examination table, easy to lie flat.

  • Equipment for aseptic procedures.

  • Aid from another HP.

  • Resuscitation equipment close-by.

3.Accuracy depends on the joint, route of entry, and health professional expertise; if available, imaging guidance, for example, ultrasound, may be used to improve accuracy.931B-2AB
4.During pregnancy when injecting a joint one has to take into account whether the compound is safe for mother and baby.984D
5.Aseptic technique should always be undertaken when performing IAT.983C
6.Patients should be offered local anaesthetic explaining pros and cons.753–4D
7.Diabetic patients, especially those with suboptimal control, should be informed about the risk of transient increased glycaemia following IA GC and advised about the need to monitor glucose levels particularly from first to third day.971BA
8.IAT is not a contraindication in people with clotting/bleeding disorders or taking antithrombotic medications, unless bleeding risk is high.893C
9.IAT may be performed at least 3 months prior to joint replacement surgery, and may be performed after joint replacement following consultation with the surgical team.883C
10.The shared decision to reinject a joint should take into consideration benefits from previous injections and other individualised factors (eg, treatment options, compound used, systemic treatment, comorbidities…).932B
11.Avoid overuse of injected joints for 24 hours following IAT; however, immobilisation is discouraged.941BA
  • A, agreement; GR, grade of recommendation; IAGC, intra-articular glucocorticoids; IAT, intra-articular therapies; LE, level of evidence.