Regular cortisone injections are among the most effective methods your doctor can use to relieve joint pain from an injury or arthritis. These injections work by reducing the inflammation in and around your joint.
We asked Michael Schaefer, MD, Director of Musculoskeletal Physical Medicine & Rehabilitation, to answer key questions about these treatments.
A: We use them most often for knee and shoulder pain, but cortisone injections can be used in any joint in the body.
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A: It is possible to give the injections indefinitely, but treating joint pain usually involves multiple approaches. Depending on what condition is causing the pain, we try to find other long-term pain relief solutions through physical therapy, bracing, other medications or, in some cases, joint replacement.
We may also use injections of platelet-rich-plasma, prolotherapy or even cell-based “stem cells” to help repair the injured or arthritic area.
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A: We try to limit the injection to one every three months for any single joint, but also we like to limit it to a total of six injections a year for the whole body.
We know that the cortisone can sometimes weaken or suppress the immune system and, in diabetics, it raises blood sugar. So we don’t use cortisone injections in people with diabetes if their blood sugar is unstable. It must be used with caution if the blood sugar is over 200.
A: There is a usually a delayed reaction. It may take up to seven days for the cortisone to take effect.
A: I do two different body parts, sometimes on the same visit, and I can adjust the dose of cortisone accordingly to limit the risks. Often, I’ll do a lower dose if we’re treating multiple body parts. I’ll use a higher dose if we’re treating a condition that’s really inflammatory, like rheumatoid arthritis or an autoimmune disorder.
A: I sometimes use artificial joint fluid injections, or what some people call “gel” injections. Those are a very good alternative treatment for knee arthritis if it is not severe enough for knee replacement.
They’re not approved for use in other joints in the United States, but they are commonly used in other countries. Occasionally, they are used in shoulders and hips — even in this country.
A: Typically, I’ll use cortisone when the joint is inflamed, or if it’s the first presentation of a bad case of arthritis, I’ll use cortisone first. But then, for ongoing injections, I prefer to use the artificial joint fluid once the inflammation settles down.
It’s got a lot of different names. Hyaluronic acid (HA) is the other most common name. In general, I prefer to use HA unless the knee seems inflamed (red and swollen) or if the patient has severe knee arthritis (bone-on-bone). In those cases, cortisone seems better.
A: Usually there isn’t any joint damage from the cortisone, but some studies have shown that it can cause damage in tendons and may predispose people to tendon rupture.
I often remind patients that inflammation is also damaging to their joints, and cortisone actually prevents this damage. However, if patients rely on multiple cortisone injections just to cover up their pain, they may eventually wear out their joints prematurely.
This is why it’s important to diagnose and treat the underlying conditions which predispose people to arthritis, such as obesity, malalignment, poor body mechanics, and inflammatory/autoimmune disorders.
A: Every injection has a small risk of infection, so patients need to keep the area where they receive the injection clean.
Also, patients shouldn’t get the injection if they have any infection, even if the infection is somewhere else in their body because of the immune system suppression. There is also a chance that there could be bacteria in the bloodstream that could get into the joints after the injection.
Remember, if you have any concerns or questions, it’s important to ask your doctor. He or she can help you by also considering your individual case and medical history.