Which practice helps minimize adverse events when using intra-articular glucocorticoids?

• A. Use the maximum dose possible at each injection
• B. Space injections at least 6 weeks apart
• C. Space injections at least 3 months apart
• D. Do not repeat injections

Answer: (C)

Spacing intra-articular glucocorticoid injections by at least three months is the best way to minimize adverse events. Repeated injections into the same joint increase cumulative steroid exposure, which can harm joint structures—cartilage and subchondral bone—as well as nearby soft tissues, leading to fat atrophy, skin depigmentation, or tendon weakening. There’s also a higher risk of systemic effects in susceptible individuals with frequent dosing. Allowing a three-month interval reduces this cumulative risk while still delivering symptom relief. Maximizing dose at a single injection raises the chance of adverse effects without eliminating the need for future injections, and avoiding repeat injections altogether can leave symptoms uncontrolled. Hence, spacing injections at least three months apart best protects the joint and patient.