Are Cortisone Injections Bad for You?

Cortisone injections can be bad for you if overused. By only giving them for the occasional, short-term relief of severe joint pain—typically when more conservative treatments have failed—healthcare practitioners can protect you from the cartilage and tendon damage that these shots can cause.

Receiving too much injected cortisone and/or getting it too often can also adversely affect bones, nerves, and skin, as well as cause your blood sugar to rise. When this treatment is used appropriately, however, the risk of these side effects is low.

This article describes how cortisone injections work, the possible risks and side effects, and the pros and cons to consider if your healthcare provider recommends treatment.

How Cortisone Works

Cortisone is a type of corticosteroid (steroid) drug used to treat inflammation. It treats inflammation by suppressing the immune system as a whole, reducing redness, pain, swelling, and warmth.

When given to a joint space—referred to as an intra-articular injection—the shot delivers an ample dose of the drug to the exact location of the inflammation (such as the knee joint or spine).

Cortisone injections are among the most commonly prescribed treatments in orthopedics, as they are able to treat arthritis, tendonitis, bursitis, and a wide range of other conditions.

Cortisone shots can also treat autoimmune joint diseases, like rheumatoid arthritis or lupus, in which the immune system launches an inflammatory assault on normal joint tissues.

Side Effects of Cortisone Injections

As beneficial as cortisone shots can be, they can cause side effects. In part, this is because of how they can impact the immune response.

Common side effects of cortisone injections include:

• Injection site pain
• Bruising
• Temporary swelling
• Redness or skin discoloration
  
• Temporary increases in blood sugar (which may be problematic for people with diabetes)

Uncommon side effects, which are more significant and typically associated with the overuse of cortisone, include:

• Softening and deterioration of joint cartilage
• Softening and rupture (tearing) of tendons
• Skin atrophy (thinning)
• Hypopigmentation (skin lightening)
• Infections at the injection site (due to suppression of the immune response)
• Edema (tissue swelling due to fluid retention)
• High blood pressure
• Osteoporosis (porous bones)
  

Are Cortisone Shots Right for You?

You healthcare provider will determine if cortisone injections are right for you by considering your diagnosis, level of success with other treatments, age, overall health, and more. There are pros and cons of these shots, each of which must be weighed on a case-by-case basis.

As effective as cortisone shots can be, they have their appropriate uses and are typically prescribed when conservative treatments (like over-the-counter painkillers,  ice and heat applications, and physical therapy) fail to reduce joint pain and swelling.

Cortisone shots are also sometimes used to delay the need for joint replacement surgery. Because the lifespan of an artificial joint is limited, orthopedists will rely on cortisone and other intra-articular injections to sustain you for as long as possible.

Benefits of Cortisone Injections

Cortisone injections can be an excellent treatment for many inflammatory conditions. Sometimes even one small dose can eliminate the inflammation at the site of the problem and alleviate pain.

Cortisone is easy to administer, and the side effects tend to be minimal. Cortisone is a substance naturally produced by the body, and while the dose is higher than your body would normally produce, it is generally well tolerated by most people.

The benefits of cortisone include:

• Cortisone is a naturally occurring substance.
• Cortisone injections can be done with minimal discomfort.
• When used appropriately, cortisone injections have few side effects overall.

Disadvantages of Cortisone Injections

Deciding whether the risks of cortisone injection outweigh the benefits can vary by your age group. For instance, if you are older and have already experienced severe joint damage due to osteoarthritis, any damage caused by cortisone may be relatively inconsequential.

The same may not be true if you are a young athlete who, say, is being given high-dose cortisone shots to "keep you in the game" after an injury. In such cases, the overuse of cortisone can cause tendons to soften and snap, causing an even greater orthopedic injury.

This is especially true for cortisone injections around the Achilles tendon. The rupture of the Achilles tendon can require surgery and cause you to be laid up for months at a time.

There are similar concerns when cortisone is used to treat plantar fasciitis (the inflammation of a thick band of tissue under the foot). Even in non-athletes, a rupture can easily occur when pressure is placed on softened tissues while walking, jogging, or climbing stairs.

In the end, the decision to use cortisone injections is an individual one in which you need to weigh the possible harms against the possible benefits.

Alternatives to Cortisone Injections

Even in the best of circumstances, cortisone shots should be used sparingly and in limited doses.

If you need more frequent injections, such as to delay joint replacement surgery, your doctor may want to intersperse cortisone shots with other intra-articular injections, including:

• Hyaluronic acid: A synthetic form of a naturally occurring compound that lubricates joints
• Platelet-rich plasma (PRP); A treatment in which blood cells, known as platelets, are extracted from whole blood and returned to the body to reduce joint inflammation and pain
• Athromsamid: A thick, non-degradable injectable gel that increases joint lubrication