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Corticosteroid (Intra-articular) Pregnancy: Use in pregnancy only after careful assessment of the benefit-risk ratio. §4.6 — methylprednisolone crosses the placenta. One retrospective study found an increased incidence of low birth weights in infants born of mothers receiving corticosteroids; in humans the risk of low birth weight appears to be dose related and may be minimised by administering lower corticosteroid doses. There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities such as cleft palate in man, but when administered for long periods or repeatedly during pregnancy they may increase the risk of intra-uterine growth retardation. Infants exposed to substantial doses in utero must be carefully observed and evaluated for signs of adrenal insufficiency. Cataracts have been observed in infants born to mothers treated with long-term corticosteroids during pregnancy. The SPC states, verbatim: 'Since adequate human reproductive studies have not been done with methylprednisolone acetate, this medicinal product should be used during pregnancy only after a careful assessment of the benefit-risk ratio to the mother and fetus.' Breast-feeding: 'Corticosteroids are excreted in small amounts in breast milk, however, doses of up to 40 mg daily of methylprednisolone are unlikely to cause systemic effects in the infant. Infants of mothers taking higher doses than this may have a degree of adrenal suppression, but the benefits of breast-feeding are likely to outweigh any theoretical risk.' Fertility: corticosteroids have been shown to impair fertility in animal studies.

Methylprednisolone Acetate 40–80mg (Depo-Medrone)

Brand names: Depo-Medrone

Methylprednisolone acetate (Depo-Medrone) is a long-acting depot corticosteroid given by intra-articular or soft-tissue injection to reduce inflammation in arthritic joints and periarticular conditions.

Adult dose

Dose: Intra-articular injection for rheumatoid arthritis or osteo-arthritis — dose depends on the size of the joint and the severity of the condition. §4.2 suggested dosage guide, verbatim: large joint (knee, ankle, shoulder) 20–80 mg (0.5–2 ml); medium joint (elbow, wrist) 10–40 mg (0.25–1 ml); small joint (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular) 4–10 mg (0.1–0.25 ml). Peri-articular soft-tissue injection for epicondylitis: infiltrate 4–30 mg (0.1–0.75 ml) into the affected area. Into the tendon sheath for tenosynovitis or epicondylitis: 4–30 mg (0.1–0.75 ml). Intrabursal for subdeltoid, prepatellar or olecranon bursitis: 4–30 mg (0.1–0.75 ml).
Route: Intra-articular, periarticular, intrabursal or into the tendon sheath. §4.2 verbatim: 'Depo-Medrone may be used by any of the following routes: intramuscular, intra-articular, periarticular, intrabursal, intralesional and into the tendon sheath. It must not be used by the intrathecal or intravenous routes.'
Frequency: Single injection. §4.2 verbatim for the intra-articular route: 'Repeated injections, if needed, may be given at intervals of one to five or more weeks depending upon the degree of relief obtained from the initial injection.' For the intrabursal route: 'In most cases, repeat injections are not needed.' For the tendon sheath route: 'In recurrent or chronic conditions, repeat injections may be necessary.'
Max: 80 mg (2 ml) into a large joint (knee, ankle, shoulder) — the highest intra-articular figure anywhere in this SPC's §4.2 dosage guide. DO NOT import the intramuscular ceiling onto this page: the SPC's intramuscular section quotes 80–120 mg for allergic conditions and 40–120 mg for dermatological and rheumatic conditions, but those are doses for sustained SYSTEMIC effect by a different route and are not an intra-articular ceiling.
The page is Methylprednisolone Acetate 40–80mg (Depo-Medrone), route 'Intra-articular injection or periarticular soft tissue injection', ortho-trauma/rheumatology — and the recovered source is the UK SPC for Depo-Medrone 40mg/ml Suspension for Injection, i.e. the page's own named brand and the correct salt (methylprednisolone acetate). Indication, route and population all match, so the §4.2 intra-articular and periarticular doses have been extracted. PAGE TITLE RECONCILED: the title's '40–80mg' sits inside the SPC's large-joint range of 20–80 mg; the SPC's own lower bound for a large joint is 20 mg, and medium and small joints are dosed lower still, so the title should not be read as a floor. This SPC lists the ankle as a LARGE joint and does not classify the hip in its dosage guide at all (it names the hip only as a suitable injection site). SINGLE USE (§4.2, verbatim): 'Depo-Medrone vials are intended for single dose use only.' Do not mix: 'Depo-Medrone should not be mixed with any other suspending agent or solution.' LOWEST EFFECTIVE DOSE (§4.2, verbatim): 'Undesirable effects may be minimised by using the lowest effective dose for the minimum period.' TECHNIQUE (§4.2): intra-articular injections should be made using precise anatomical localisation into the synovial space; ensure correct needle position and aspirate a few drops of joint fluid, replace the aspirating syringe with one containing Depo-Medrone, then inject and move the joint slightly to aid mixing. Suitable intra-articular sites are the knee, ankle, wrist, elbow, shoulder, phalangeal and hip joints; 'The spinal joints, unstable joints and those devoid of synovial space are not suitable.' 'Treatment failures are most frequently the result of failure to enter the joint space.' ACHILLES (§4.2 and §4.4, verbatim): 'Due to the absence of a true tendon sheath, the Achilles tendon should not be injected with Depo-Medrone.' AFTERCARE (§4.2, verbatim): 'Subsequent to therapy care should be taken for the patient not to overuse the joint in which benefit has been obtained.' SYSTEMIC ABSORPTION (§4.4, verbatim): 'Systemic absorption of methylprednisolone occurs following intra-articular injection of Depo-Medrone. Systemic as well as local effects can therefore be expected.' The SPC's intralesional dermatological dose (20–60 mg for keloids, lichen planus etc.) has deliberately NOT been carried onto this page — it is a different indication and route from this page's primary identity.

Paediatric dose

Route: Intra-articular or periarticular
Frequency: Specialist-guided; the SPC gives no paediatric interval
Max: Not stated for children in this SPC — no numeric paediatric dose or ceiling is given
Concentration: 40 mg/ml
NO NUMERIC PAEDIATRIC DOSE IN THIS SOURCE — dosePerKg is deliberately null and must not be filled in. This SPC gives no paediatric milligram or per-kilogram figure at all. §4.2 Paediatric population, verbatim and in full: 'Dosage may be reduced for infants and children but should be governed more by the severity of the condition and response of the patient, than by age or size.' Do not derive a paediatric dose by scaling the adult range. The concentration field is 40 because the sourced product is 'Depo-Medrone 40mg/ml Suspension for Injection', i.e. 40 mg per mL.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to the active substance or to any of the excipients listed in section 6.1
  • Systemic infection, unless specific anti-infective therapy is employed
  • Use by the intrathecal route (due to its potential for neurotoxicity)
  • Use by the intravenous route
  • Administration of live or live, attenuated vaccines in patients receiving immunosuppressive doses of corticosteroids
  • Not a formal §4.3 contraindication but a §4.2/§4.4 prohibition: the Achilles tendon should not be injected, due to the absence of a true tendon sheath

Side effects

  • NOTE: §4.8 was cut off at the source-fetch limit part-way through the adverse reaction table (the list stops inside 'Gastrointestinal disorders'), so this list is PARTIAL — consult the full SPC
  • Injection site infection; opportunistic infection; increased susceptibility to and severity of infections with suppression of clinical symptoms and signs; recurrence of dormant tuberculosis (not known)
  • Skin depressions at the injection site — dermal and/or subdermal atrophy; the degree varies with the amount of steroid injected and regeneration is usually complete within a few months (§4.4)
  • Subcutaneous atrophy and depigmentation, particularly with superficial injection and in deeply pigmented skin (§4.4)
  • Hypothalamic pituitary adrenal axis suppression; Cushingoid appearance; withdrawal symptoms — too rapid a reduction of corticosteroid dosage after prolonged treatment can lead to acute adrenal insufficiency, hypotension and death (not known)
  • Glucose tolerance impaired; increased requirements for insulin or oral hypoglycaemic agents in diabetics; sodium retention; fluid retention; hypokalaemic alkalosis; metabolic acidosis; dyslipidaemia; increased appetite with weight increase (not known)
  • Affective disorder including depressed mood, euphoric mood, affect lability, suicidal ideation; psychotic disorder; confusional state; anxiety; insomnia; irritability — mood swings, abnormal behaviour, insomnia and psychotic disorder were most common in children (not known)
  • Increased intracranial pressure with papilloedema (benign intracranial hypertension); seizure; amnesia; cognitive disorder; dizziness; headache (not known)
  • Cataract; glaucoma; increased intra-ocular pressure with possible damage to the optic nerve; vision blurred; chorioretinopathy; rare instances of blindness associated with intralesional therapy around the face and head (not known)
  • Drug hypersensitivity; anaphylactic and anaphylactoid reaction (not known)
  • Hypertension; hypotension; arterial embolism; thrombotic events; flushing; pulmonary embolism; congestive cardiac failure in susceptible patients (not known)
  • Severe medical events have been reported in association with the intrathecal/epidural routes of administration (§4.4)

Monitoring

  • Use the lowest effective dose for the minimum period; frequent patient review is required to titrate the dose against disease activity (§4.4)
  • Take precautions to avoid intravascular injection — aspirate before injecting (§4.2, §4.4)
  • Do not exceed recommended doses, to minimise dermal and subdermal atrophy; make multiple small injections into the area of the lesion whenever possible (§4.4)
  • Avoid injection into the deltoid muscle because of a high incidence of subcutaneous atrophy (§4.4)
  • Expect systemic as well as local effects — methylprednisolone is systemically absorbed after intra-articular injection (§4.4)
  • After more than physiological doses (approximately 6 mg methylprednisolone) for greater than 3 weeks, withdrawal should not be abrupt; once a daily dose of 6 mg methylprednisolone is reached, dose reduction should be slower to allow the HPA axis to recover (§4.4)
  • Adrenal cortical atrophy develops during prolonged therapy and may persist for months after stopping treatment (§4.4)
  • Advise the patient not to overuse the injected joint afterwards (§4.2)
  • This list may be incomplete — check the full SPC.

Clinical monograph

How it works

As a glucocorticoid it binds intracellular receptors to suppress local inflammatory mediator production and immune cell activity; the acetate ester provides a poorly soluble depot for prolonged local action.

Prescribing in practice

  • Never inject into a joint that may be infected (septic arthritis), as intra-articular corticosteroid can worsen infection and obscure its signs.
  • Use strict aseptic technique and limit repeated injections into the same joint to avoid cartilage damage and tendon weakening.
  • Systemic absorption can cause a transient blood glucose rise and HPA-axis effects, relevant in diabetic and immunosuppressed patients.

Monitoring

Review the joint after injection for response and signs of post-injection flare or infection, and monitor glucose in diabetic patients.

Counselling the patient

  • A short-lived flare of pain in the first day or two can occur before benefit is felt.
  • Seek urgent review if the joint becomes hot, increasingly swollen, or you develop a fever.
  • Diabetic patients should monitor blood glucose, which may rise temporarily.

Evidence & guidelines

Intra-articular corticosteroid injection is an established option for inflammatory and osteoarthritic joint pain in UK rheumatology and orthopaedic practice.

Reference: NICE NG226 (Osteoarthritis); BSR Guidelines for Intra-articular Injections; BSMS Joint Injection Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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