Depo-medrone intraarticular injections for patients on NSAID

RE: Depo-medrone intraarticular injections for patients on NSAID

David Mills — Wed, 08 Jan 2025 23:33:23 GMT

There is literally naff all evidence that steroids co administered with a cox-2 inhibitor , in our patients, is any more dangerous than NSAIDS + placebo.

I seem to remember the Liverpool pool pain guys recommending 5mg pred alongside NSAIDS for chronic OA. My old lab was on this for years every day and was better with the pred. No side effects.

So injecting a tiny amount into a joint? Irrelevant.

The whole premise of cst/NSAIDS danger is based on nothing but opinion and a defensive mindset. So we have a specialist saying leave 7 days. Why? What about 6? Or 8? What is that based on? It's not scientific.

The same goes for testing for infectious OA. IT IS SO UNCOMMON AS TO BE FANTASTICAL. Esp in 1st opinion. By all means do a slide. But I'll bet you my RCVS fee it will be negative.

Remember the population you see compared to those in referral or different geographies - in many cases they are chalk and cheese.

RE: Depo-medrone intraarticular injections for patients on NSAID

Andy Moores — Wed, 08 Jan 2025 19:15:27 GMT

Hi Tom,

I would echo Michael's comment about checking for infection first. Arthritic joints are at higher risk of developing septic arthritis of haematogenous origin and infection is not an unusual cause of a deteriorating OA joint. Cytology is sufficient (cultures are often negative even if there is infection present).

I don't worry about recent NSAID use if I'm using IA steroid, but I do stop NSAIDs for at least a week after the injection unless the dog is in severe pain. I don't have any pharmoacokinetic data to back this up but it feels safer to me than keeping the NSAIDs going. I have never knowingly seen a steroid/NSAID issue following IA steroid.

Best wishes, Andy

RE: Depo-medrone intraarticular injections for patients on NSAID

Lesley Strong — Tue, 07 Jan 2025 22:53:35 GMT

Good old Poorly Leg Tablets ( how I miss them as well as Alugan, panalog and kaobiotic!!)Extended the life of many rickety old labs. You just had to not inhale the dust at the bottom of the pot. Instant asthma attack

Yes over the years seen steroid with nsaid with no adverse effects and good improvements

RE: Depo-medrone intraarticular injections for patients on NSAID

Michael Woodhouse — Tue, 07 Jan 2025 22:43:58 GMT

Worth a try, let us know. I'd gather a few drops of joint fluid, when needle in there, and diff quick it......

RE: Depo-medrone intraarticular injections for patients on NSAID

Tom Ward — Tue, 07 Jan 2025 22:33:01 GMT

Thanks Michael. The dog is already on Librela and meloxicam (agree seems one of the more effective nsaids in my experience). I do remember PLT but it disappeared very soon after I qualified so saw it in patient histories more than I prescribed it!! The joint is very thickened now with a very limited ROM and I do wonder whether a bit of local steroid might do him some favours.

RE: Depo-medrone intraarticular injections for patients on NSAID

Michael Woodhouse — Tue, 07 Jan 2025 22:15:53 GMT

Some of the human literature helpfully states that there 'may' be systemic effects. Some cases describe suppression of the HPA and others that is not the case.

What would I do (if that helps)? I think I'd lean towards rule out sepsis and then explore other methods of analgesia 1st. Librela, paracetamol would both come before steroid. I would also question which NSAID the dog is on, as some suit some dogs better and my clinical impression is some of the older drugs (especially meloxicam) work more effectively, where COX sparing ones maybe don't.

I have used systemic steroids with NSAIDs and never had a problem. Are you old enough to remember PLT? I have added in small amounts of particularly pred (5-10mg/30kg lab) as a last ditch attempt at relief to mostly positive results, alongside NSAIDs. I get off-licence form signed but have never seen a problem. I also have various tales of the drugs used concurrently, by accident or on purpose, with no issues. Depo in a joint is a small dose.

I'd discuss with owner, try other things first, but would be happy using intra-articular Depo (0.5ml) alongside NSAIDs. I don't believe any silly gastroprotectant will do anything, so save that.