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NICE guidelines support the use of intra-articular corticosteroids for pain relief in arthritis

NICE clinical guideline Rheumatoid Arthritis (RA) NG100

Initial pharmacological management 

Conventional DMARDs

For adults with newly diagnosed active RA:

Offer first-line treatment with conventional disease-modifying anti-rheumatic drug (cDMARD) monotherapy using oral methotrexate, leflunomide or sulfasalazine as soon as possible and ideally within 3 months of onset of persistent symptoms.
Consider hydroxychloroquine for first-line treatment as an alternative to oral methotrexate, leflunomide or sulfasalazine for mild or palindromic disease. Escalate dose as tolerated.1

Consider short-term bridging treatment with glucocorticoids (oral, intramuscular or intra-articular) when starting a new cDMARD.1

Offer additional cDMARDs (oral methotrexate, leflunomide, sulfasalazine or hydroxychloroquine) in combination in a step-up strategy when the treatment target (remission or low disease activity) has not been achieved despite dose escalation.1

Further pharmacological management


Offer short-term treatment with glucocorticoids for managing flares in people with recent-onset or established disease to rapidly decrease inflammation. 

In people with established RA, only continue long-term treatment with glucocorticoids when:

  • The long-term complications of glucocorticoid therapy have been fully discussed, and
  • All other treatment options (including biological drugs and targeted synthetic DMARDS) have been offered.1

NICE clinical guideline 177 Osteoarthritis (OA)

Intra-articular corticosteroid injections should be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with osteoarthritis.2


1. NICE clinical guideline NG100 Rheumatoid arthritis. Issue date: July 2018.
2. NICE clinical guideline 177 Osteoarthritis. Issue date: February 2014.