Corticosteroid — Intra-articular / Intramuscular Pregnancy: Use with caution — single-dose IA injection generally considered low risk; avoid IM high-dose systemic use in first trimester

Triamcinolone Acetonide (Intra-articular)

Brand names: Kenalog, Adcortyl

Adult dose

Dose: Large joint (knee, shoulder, hip): 40 mg; Medium joint (wrist, elbow, ankle): 20 mg; Small joint (MCP, PIP): 5–10 mg

Route: Intra-articular injection (or deep IM for Kenalog 40 mg in PMR/RA flare)

Frequency: Typically no more than 3 times per year per joint; IM every 3–4 weeks if used for systemic effect

Max: 40 mg per large joint injection

Ultrasound guidance improves accuracy for small and deep joints. Post-injection rest for 48 hours improves outcomes. Infection must be excluded before intra-articular injection — septic arthritis is a contraindication.

Paediatric dose

Route:

Paediatric joint injections — seek specialist opinion; doses lower and usually under USS guidance; GA often required in young children

Dose adjustments

Renal

No dose adjustment required; monitor for fluid retention

Hepatic

Use with caution; corticosteroids are hepatically metabolised

Clinical pearls

Triamcinolone is the preferred steroid for intra-articular injection in UK rheumatology practice — longer duration of action (4–8 weeks) compared to methylprednisolone acetate (Depo-Medrone, 2–4 weeks)
Kenalog 40 mg IM is commonly used as a bridge therapy in PMR and RA flares — offers systemic effect without daily oral steroid burden
Post-injection flare (crystal-induced synovitis) occurs in 2–10% within 24 hours — reassure patients; treat with ice, rest, NSAIDs; distinguishable from septic arthritis by shorter onset and rapid resolution
Skin atrophy: avoid injecting too superficially — particularly around tendons; depigmentation can be permanent in dark-skinned patients
NICE and BSR guidance: repeat joint injection at intervals <3 months is not recommended for the same joint — risk of cartilage damage and systemic effects

Contraindications

Suspected septic arthritis
Joint instability or prosthetic joint (increased infection risk)
Skin infection at injection site
Haemarthrosis without diagnosis
Previous hypersensitivity to triamcinolone

Side effects

Skin atrophy and depigmentation at injection site — especially in superficial tendons and dark skin
Post-injection flare — pain 12–24 hours after injection (crystal-induced); usually self-limiting
Transient hyperglycaemia — caution in diabetes; monitor blood glucose for 72 hours
HPA axis suppression (after repeated injections or high IM doses)
Septic arthritis (risk ~1:15,000 per injection — strict aseptic technique mandatory)
Cartilage damage — theoretical concern with very frequent injections

Interactions

Anticoagulants — relative contraindication for joint injection; risk of haemarthrosis
Antidiabetic agents — dose adjustment may be needed for 72 hours post-injection

Monitoring

Blood glucose in diabetic patients — 24–72 hours post-injection
Signs of infection post-injection
Blood pressure if frequent IM injections

Reference: BNFc; BNF 90; BSR/BHPR Intra-articular Injection Guidelines; SPC Kenalog. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways