Avoid glucocorticoid joint injections without clear evidence of inflammation

Rationale:

Treatment and treatment goals are based on shared decision-making between the patient and the rheumatologist, and, in most arthritis diseases, the goal is remission. As long as the treatment goal has not been achieved, baseline therapy should be adjusted. In cases of disease flare, glucocorticoid injections may be considered in joints with confirmed arthritis. A recent study shows that glucocorticoid injections are most effective in joints with ultrasound-verified arthritis with moderate Doppler activity, regardless of whether the joint is swollen or not. 

References:

• Nasjonal prosedyre for diagnostikk, behandling og oppfølging av revmatoid artritt i Norge. A. B. Aga og E. A. Haavardsholm. https://legeforeningen.no/Fagmed/Norsk-revmatologisk-forening/Fagradets-innstillinger/Ferdige-norske-prosedyrer/
• The Impact of Ultrasound on the Use and Efficacy of Intraarticular Glucocorticoid Injections in Early Rheumatoid Arthritis: Secondary Analyses From a Randomized Trial Examining the Benefit of Ultrasound in a Clinical Tight Control Regimen. L. B. Norberg et al. Arthritis & Rheumatology 2018.