Cortisone injections can be used to reduce inflammation (redness, swelling) and pain in a joint and its surrounding structures. In arthritis, this may be considered when there is a flare-up or the pain in a joint is not responsive to other treatments. Cortisone is a substance similar to a natural steroid hormone produced by the body. Cortisone is also referred to as a ‘corticosteroid’. Corticosteroids are different from the steroids used by some bodybuilders and athletes – these are ‘anabolic steroids’.
When is a cortisone injection given?
Cortisone injections may be useful on occasion for various types of arthritis, including gout, rheumatoid arthritis, and osteoarthritis. The injection may also be given in other conditions, such as tendinitis and tennis elbow.
In general terms, in arthritis, cortisone injection may be considered:
- when pain due to inflammation is severe either in a joint or the surrounding structures
- if only a few joints are involved
- if specific joints are preventing activity
- if other medication cannot be used.
What are the benefits of cortisone injections?
Benefits of cortisone injections include:
- pain and swelling are reduced
- mobility is increased
- often, as the pain settles, other medications can be reduced
- it may be combined with other treatment such as physiotherapy.
The injection procedure
The method used in giving the injection into a joint is similar to that of soft tissue injections. Before injection a separate syringe and needle is used to remove any excessive amount of fluid in the joint (aspiration of joint). Your doctor is then able to examine the fluid and send a sample to the laboratory for diagnosis. The reduced pressure of the fluid in the joint also relieves the pain and may help the joint to heal.
Special preparations are used to prolong the effect of cortisone at the site of injection. Cortisone starts to act slowly over 24-36 hours and the beneficial effects may last for days or months. Local anaesthetic may also be given. This relieves pain immediately and lasts for three to four hours while the cortisone is beginning to take effect.
After treatment with cortisone injections
To prolong the action of the cortisone in the joint or surrounding structures, it is important to:
- rest the joint for about 24 hours
- avoid excessive movement or stress on the joint for about one week. Sometimes there is increased pain after injection which settles within 24 hours
- if there is pain you should rest, apply ice and take pain relief such as paracetamol (or as advised by your doctor).
If the pain worsens over 48 hours and/or you feel unwell, contact your doctor without delay (may be a sign of infection).
As cortisone is injected infrequently into a specific site, very little enters the bloodstream compared with cortisone taken in tablets. Because of this, cortisone side effects from injection are usually minimal in comparison.
Cortisone side effects are uncommon. Possible effects include:
- swelling of fingers or face (oedema)
- menstrual irregularity
- mood changes
- raised blood pressure
- thinning (atrophy) or altered colour of the skin at the site of the injection. This rarely occurs with joint injection, but may with injections of surrounding structures, eg. tennis elbow
- raised or unstable blood glucose levels in people with diabetes for several days following injection.
Infection risk: There is a small risk of infection from the injection into a joint. Contact your doctor promptly if the joint/area is hot and swollen, you develop a fever, pain does not go away after 48 hours or pain develops after this time. Infection in a joint can be serious, so it is important to get medical advice as soon as possible.
Discuss potential risks and benefits with your doctor before having a corticosteroid injection.
See also: Medications for arthritis and Arthritis and physiotherapy
Original material by everybody. Reviewed and edited by everybody, February 2013.