Overview of Steroid Injections for Osteoarthritis

Knee infiltration
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Corticosteroid injections, or steroid injections, are used to improve joint function while reducing local joint inflammation. Steroids are synthetic drugs that act like the naturally occurring hormone hydrocortisone, or cortisol. Injections are administered directly into the affected joint, such as the shoulder, elbow, hip, knee, hand, back or wrist.

About Hydrocortisone

Hydrocortisone is similar to a hormone produced by the adrenal glands. In addition to treating arthritis, it is used to treat asthma and certain skin, blood, kidney, eye, thyroid, and intestinal disorders. It can also be used to combat the side effects of other medications, although it's known to produce some side effects of its own, including, but not limited to:

  • Nausea
  • Headache
  • Dizziness
  • Vomiting
  • Restlessness
  • Increased sweating

If you experience any of the following symptoms after a steroid injection, contact your doctor immediately:

  • Vision problems
  • Muscle pain
  • Weakness
  • Skin rash
  • Swollen feet, ankles and lower legs
  • Unusual bleeding
  • Black, tarry stool

What to Know Before You Try Steroid Injections

  1. Steroid injections deliver a concentrated dose of medication to the affected joint. This is a very effective way to knock down inflammation.
  2. Steroid injections can be delivered into the site of bursitis (inflamed bursa), or around tendons at the shoulder, hip, elbow, knee, hand, and wrist; not just into a joint.
  3. A sterile technique must be used for steroid injections in order to reduce the risk of infection. There is some risk of infection whenever the skin is punctured for an injection.
  4. Steroid injections can be used as an adjunct therapy along with systemic therapy. In other words, the patient can continue taking other medications while receiving a steroid injection or a series of injections. Steroid injections can also be used alone for people who do not tolerate other treatments.
  5. Joint fluid can be aspirated at the same time when a steroid injection is planned. The joint fluid can be sent on to the laboratory for testing.
  6. The standard recommendation is that no more than three steroid injections should be administered to the same joint per year. If a joint is injected too frequently, there is a risk of bone deterioration and progressive cartilage damage. Bones, ligaments, and tendons can also become weaker with too frequent steroid injections.
  1. Steroid injections should not be administered if a joint is already infected or if there is an active infection anywhere else in the body. There are risks and benefits that must be weighed when considering steroid injections.
  2. A common side effect of steroid injections occurs when the injected hydrocortisone crystallizes and causes a flare of pain that can last for a few days. Icing the injected area can help to alleviate pain.
  3. Overuse of the joint during the first 6 hours after an injection has been administered can seriously aggravate arthritis. The medication that is injected is typically a combination of the steroid and a local anesthetic. While a patient is still feeling the effects of the anesthetic, they may unknowingly put too much stress on their arthritic joint.
  4. There are quite a few different types of steroids doctors use. However, many doctors tend to prefer Depo-Medrol, Aristospan, Kenalog, and Celestone.
  5. Patients probably won't notice results right away. As local anesthetic wears off after the injection, it may take several days to notice the expected benefit.
  1. It's important to remember that steroid injections are used to decrease pain and inflammation while consequently improving function. The steroid injections do not, however, cure the disease.
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    Article Sources

    • Hydrocortisone Injection. MedlinePlus Drug Information. 
    • Steroid Injections. Cleveland Clinic. 
    • Corticosteroid Injections. Primer on the Rheumatic Diseases. Edition 12. Published by the Arthritis Foundation.