ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Corticosteroid (Intra-articular)

Methylprednisolone Acetate 40–80mg (Depo-Medrone)

Brand names: Depo-Medrone

Adult dose

Dose: Large joints (knee, shoulder, hip): 40–80mg. Medium joints (elbow, wrist, ankle): 20–40mg. Small joints (MCP, PIP): 4–10mg. Soft tissue (tendon sheath, bursa): 4–40mg.
Route: Intra-articular injection or periarticular soft tissue injection
Frequency: Single injection; may repeat every 3 months (max 3–4 injections per joint per year)
Max: 80mg per large joint injection
Avoid in suspected septic arthritis (exclude infection before injecting). Strict aseptic technique essential. Post-injection flare (crystal-induced): lasts 24–48h, resolves spontaneously. Advise rest for 24–48h post-injection.

Paediatric dose

Route: Intra-articular
Frequency: Specialist-guided
Max: JIA: 1 mg/kg per large joint (max 40mg)
Concentration: 40 mg/mL, 80 mg/2 mL N/A/ml
Juvenile idiopathic arthritis (JIA): intra-articular triamcinolone hexacetonide preferred in children (longer duration). Depo-Medrone used if hexacetonide unavailable. Specialist paediatric rheumatology.

Dose adjustments

Renal

No dose adjustment required for intra-articular use

Hepatic

No dose adjustment required for intra-articular use

Clinical pearls

  • Septic arthritis exclusion is MANDATORY before any intra-articular injection — aspirate first if in doubt; send synovial fluid for MC&S, WCC, crystals
  • Diabetic patients: warn about blood sugar rise 24–72h post-injection; instruct to monitor and contact GP if significantly elevated
  • Frequency limit: >3–4 injections per year may cause cartilage damage — document and limit
  • Post-injection advice: rest joint 24–48h, avoid strenuous activity for 2 weeks for best effect
  • Informed consent: document discussion of risk of infection, hyperglycaemia, post-injection flare

Contraindications

  • Suspected septic arthritis (ABSOLUTE — must exclude infection first)
  • Bacteraemia
  • Prosthetic joint infection
  • Skin infection overlying injection site
  • Bleeding disorder (relative)
  • Anticoagulation (relative — discuss risk)

Side effects

  • Post-injection flare (24–48h — crystal-mediated, self-limiting)
  • Joint infection (rare — <1 in 50,000 injections with aseptic technique)
  • Skin atrophy and depigmentation (if injection deposits subcutaneously)
  • Transient hyperglycaemia (significant in diabetics — warn and advise monitoring)
  • Systemic absorption (HPA axis suppression with repeated injections)

Interactions

  • Anticoagulants — increased bleeding risk at injection site (discuss with patient)
  • Hypoglycaemic agents — transient effect on blood sugar control

Monitoring

  • Blood glucose (in diabetics, 24–72h post-injection)
  • Signs of infection post-injection (fever, increased pain, warmth)
  • Number of injections per joint per year (documentation)

Reference: BNFc; BNF; NICE NG226 (Osteoarthritis); BSR Guidelines for Intra-articular Injections; BSMS Joint Injection Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways