Bmj Usa


BMJ 2004; 328 doi: (Published 10 June 2004) Cite this as: BMJ 2004;328:E305
  1. Sidha S Sambandan, general practitioner
  1. Norwich, UK
  2. Bristol, UK

    Following are edited excerpts from the Rapid Responses generated by this article, all of which can be read in their entirety at

    Having used methylprednisolone and lidocaine (80 mg) for more than 15 years for osteoarthritis of the knee that did not respond to conservative treatment, I have found that a significant proportion of patients have had pain relief lasting up to five years. Anecdotal as it may seem, elderly patients, especially those who do not wish to have surgery, are very grateful for the pain relief.

    I have also had a few very elderly patients [to whom I have given injections], so that they could fly [overseas to visit] family in the US and Canada. The steroids enabled them to cope with the mechanical stress on the joints as a result of the traveling and extra walking they had to do while on holiday.

    1. Louis I Jones, retired general practitioner
    1. Norwich, UK
    2. Bristol, UK

      I have used this procedure since 1961, and the reduction of pain and improvement in function is enhanced if any effusion is aspirated at the same time. Aspiration also aids diagnosis.

      It is a simple procedure that can be done easily in a general practitioner's office as long as a 19 gauge, 1 1/2 inch needle is used, because osteoarthritis fluid is viscous and will not flow through a smaller one. I use 80 mg of methylprednisolone together with some lidocaine. Improvement lasts from a few months to a few years.

      Details of technique: Draw up 5 mL of 1% lidocaine in a 10 mL syringe. Using a 19 gauge needle, infiltrate the lidocaine from the skin to the joint cavity. The best approach is beneath the lateral border of the patella. Aspirate any effusion completely. Clear viscous fluid indicates osteoarthritis. Cloudy non-viscous fluid indicates an inflammatory effusion, and a sample should be sent for microscopy and culture. If fluid is clear or absent, with the 19 gauge needle still in situ inject 80 mg of methylprednisolone into the joint space.

      View Abstract

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