Cortisone Injection (Steroid Injection)
Cortisone is a naturally occurring corticosteroid hormone produced by the body’s adrenal glands. Corticosteroids are a class of medications that are related to natural cortisone and can help to relieve the pain and swelling from arthritis.
In rheumatology, corticosteroids may be called steroids (for short) and sometimes cortisone. Corticosteroids are very different from the risky anabolic steroids that cheating athletes and bodybuilders take to artificially boost testosterone levels and enhance athletic performance.
Examples of corticosteroids inlcude methylprednisolone (depomedrol), triamcinolone (kenalog or aristospan), and betamethasone (celestone).
Steroid injections can be a valuable treatment for many types of arthritic conditions including inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis, gout, and lupus. Patients with osteoarthritis and conditions like tendonitis, bursitis, and tendon nodules can also benefit from steroid injections.
Taking Cortisone Injection
How Cortisone is Injected
Steroids are injected locally: either directly into the joints (intra-articular) or around the joints (peri-articular) or tendons being treated. They reduce inflammation (heat, redness, swelling, and pain) in and around the injected joint. The dosage varies depending on the kind of corticosteroid.
Most injections are safely and routinely performed in a physician’s office. For joints in the spine or hip, injections are usually given by a radiologist with help from an x-ray or ultrasound.
A local anesthetic (lidocaine) is sometimes given before the injection (or it can be mixed with the steroid) to give immediate relief.
How Long Cortisone Lasts
Most injections typically take 24-48 hours to take full effect. If local anesthetic was given with the steroid injection, patients may feel improvement relatively quickly. The duration of improvement varies. Some patients report months of relief whereas others find only a few days of relief.
If possible, it is best to rest the joint or tendon for 24-48 hours after the injection. This may make the injection work better and last longer.
Patient Response and Repeat Treatments
In general, if a patient is going to respond to a steroid injection, they tend to respond after the first injection. Patients who have gained no symptom relief or functional benefit from two injections should probably not continue with repeat injections because the likelihood of improvement is small.
If a significant benefit is achieved after the first injection, then an argument can be made for a repeat injection. There is some controversy in the medical community that too many injections may weaken tendons, ligaments, and accelerate the loss of cartilage; but other studies have found that injections can slow joint damage and help preserve the joint. A reasonable approach is to limit the frequency of injections to 3-4 for a single joint per year.
Important Tests and Risks
The vast majority of steroid injections go smoothly and there are no serious side effects.
A small and very rare risk is that the injected joint becomes infected (1 in 15,000). Patients who experience a very painful, red, or swollen joint after injection should seek medical attention immediately. Thankfully, the most common cause of these symptoms is not a concerning infection but a reaction to the injected steroid (called steroid flare) that occurs in 2-5% of patients. A steroid flare usually begins 6-12 hours after the injection and can last for 2-3 days. Regardless of the cause, it is important for patients with symptoms of infection to see a doctor because infections require immediate treatment.
In patients with diabetes, a steroid injection can sometimes cause a rise in blood sugars. These patients should make sure to test their blood sugars for a few days after the injection.
Joint injections are not usually recommended within 3-months of surgery on a joint because this can increase the risk of infection.