Cortisone Injections

What is a Steroid?

Corticosteroids are made naturally within the body. The type of steroids used medically should not be confused with the types sometimes used (or abused) by, for example Bodybuilders. Medical corticosteroids have a role to play in controlling inﬂammatory responses.

There are several types of steroid used for joint and soft tissue injections. These are synthetic (man-made) corticosteroids. They mimic the action of naturally made corticosteroids which your own body can produce in certain glands and have a good safety record when used appropriately.

Do you need to rest the area/joint after injection?

It is recommended to rest a joint that has been injected for 48 hours, this helps the injection work better. If this is impractical then it is advisable to avoid any strenuous exercise for the following 48 hours. A sound general principle is to move the joint injected as normal but do not lift or push heavy objects for a week after the injection.

Are you Diabetic?

The steroid can make your blood sugar higher than normal. You need to check your blood more often for a week. You may need to increase your insulin. Contact your diabetes specialist for advice if your blood sugar is high.

Are you receiving other very specialist treatments?

If you are having 'Biologic Therapies' such as anti-TNF therapy, or other biologic therapies, we can still inject your joints. However, you must be especially quick to tell us if you have any signs of infection in your joint. The infection could be worse because you are taking a medication that aﬀects your body's natural defences against infection.

Risks or side eﬀects

Side eﬀects are rare. Very occasionally people notice a ﬂare in their joint pain within the ﬁrst 24 hours. This usually settles within a couple of days. The most important but very rare side eﬀect of treatment is infection in your joint – this is very rare indeed and would not usually occur more than once in every 20,000 injections. If you have a high temperature and your joint becomes; Hot, Red, Swollen or Painful, then you should contact your practitioner direct or go to the Accident and Emergency department if unable to get hold of us here.

Some patients experience facial ﬂushing after an injection or itching at the injection site. These symptoms should settle within the ﬁrst few days, very occasionally you may see some thinning or discoloration of the skin which may occur at the site of the injection. This is called depigmentation and may take longer to fade; sometimes it has a permanent eﬀect. Women may, rarely, have some changes in their normal cycle after an injection. This is more likely if you have more than one joint injected. If it lasts longer than one cycle then consult your doctor.

You may take other medications with steroid injections, but it is important that you discus all of your other medicines with us. It is important you tell us if you are taking a drug that thins your blood (an anticoagulant) such as Warfarin, you should bring your monitoring booklet showing your recent INR results. You should arrange a repeat INR 3 days after the injection.

How do Cortisone Injections Work?

Steroids work within cells. They prevent the release of certain chemicals produced by the immune system. These chemicals are responsible for immune reactions, which lead to inﬂammation.

In autoimmune conditions such as Rheumatoid Arthritis and Lupus and inﬂammatory diseases the immune system is over active. This means the production of these chemicals is higher than normal. Steroids reduce the production of these chemicals.

This has the eﬀect of lessening the inﬂammation. The joint or tissue can then become less swollen and less painful.

If you would like any further information about steroid injections, or if you have any concerns about your treatment, please discuss this with your clinician.