Steroid Injections for Arthritis, Gout, and More

Steroid injections, also known as cortisone injections, are used to manage joint pain caused by arthritis. These corticosteroid drugs are often used to treat knee pain, nerve pain from sciatica in the lower back, and arthritic pain caused by gout.

Steroid injections are a synthetic version of the natural corticosteroids your body makes to control inflammation, manage stress, and support other functions. These injections can be made within an affected joint, in the buttocks or other muscles, or into a vein for a systemic effect.

This article explains how cortisone injections for arthritis are administered, and what to expect if you receive steroid injections for knee pain, gout, or another condition. It also discusses the side effects.

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Steroid Injections for Arthritis

Cortisone injections for arthritis are used to control inflammation. There are several ways that corticosteroids can be administered, including:

• Steroid injections directly into a joint or other tissue
• Systemic oral medications to treat the whole body
• Intravenous (IV) cortisone injections
• Intramuscular injections to treat a specific site

Steroid injections for knee pain or other musculoskeletal conditions may provide significant relief.

For patients with rheumatoid arthritis, the injections are typically offered when only one or two joints display active synovitis. The goal of treatment is to quell symptoms of a flare-up, or to enable slower-acting drugs, such as Trexall (methotrexate) or Plaquenil (hydroxychloroquine), time to work.

People often wonder how long they have to rest after a steroid injection, or how long after a cortisone shot they can walk again. The answers vary depending on the joint that's being treated, your overall health, and your healthcare provider recommendations.

Taking steroid injections for knee pain as an example, it's likely that you will have to limit walking or other weight-bearing activity for a day or two after an injection. This gives it the best chance to be effective. Overuse in the first six hours after cortisone injection can actually aggravate arthritis.

Keep in mind that a local anesthetic is typically combined with the steroid. This may mask any pain, so you may note be aware that you are putting too much stress on your joint after a cortisone injection for arthritis. Expect it to take up to 10 days for the full benefits of treatment to take effect.

The type of steroid injection you have may vary, in part depending on your provider's preference. Some of these cortisone injection options include:

• Depo-Medrol (methylprednisolone acetate)
• Aristospan (triamcinolone hexacetonide)
• Kenalog (triamcinolone acetonide)
• Celestone (betamethasone)

Cortisone Injections for Gout

Gout is a common form of arthritis with similar symptoms of joint pain and inflammation, though for a different reason. It affects joints, often the big toe, because uric acid builds up in the body.

Lifestyle choices, including diet and the consumption of foods high in prurine, contribute to gout, as do obesity and alcohol use. People with certain health conditions, such as chronic kidney disease, also are more likely to develop gout.

A nonsteroidal anti-inflammatory drug (NSAID) like Aleve (naproxen) or Advil (ibuprofen) is often used to treat gout, but cortisone is a treatment option for some people experiencing gout flare-ups.

Research that compares both NSAID and systemic corticosteroid drugs used to manage gout found both deliver similar results in pain management, but the systemic corticosteroids cause fewer side effects. Steroid injections also may be used if only one or two joints in the body are affected.

Side Effects

Most people do not experience steroid injection side effects, especially when they closely follow their healthcare provider's instructions and have cortisone injections at the right intervals.

However, potential side effects of steroid injections include:

• Increased pain or swelling of the joint in the first 24 hours
• Swelling, redness, or increased pain after 24 hours (may signal a joint infection)
• Tendon rupture
• Skin discoloration
• Local bleeding
• Infection
• Allergic reaction

A local steroid injection into the buttocks muscle provides a systemic effect. As with oral corticosteroids, it is uncertain how much of the systemic medication reaches any specific joint.

Also, if the injection into the buttocks is repeated frequently, it can increase the risk of developing some common side effects seen with oral steroids, including osteoporosis and cataracts.

If a specific joint is involved, then a steroid injection for knee pain or another joint typically will go into that joint rather than using a systemic treatment approach. Local steroid injections are well-tolerated and less likely to be associated with serious side effects compared to oral corticosteroids.

Keep in mind, though, that steroid injections for arthritis may be less effective when the affected joint is severely damaged.