Arthritis Treatment Steroid Injections and Arthritis Cortisone Shots Help Reduce Inflammation Locally or Systemically By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by Scott Zashin, MD on September 23, 2020 linkedin Scott J. Zashin, MD, is board-certified in internal medicine and rheumatology. He was a volunteer clinical professor of internal medicine at the University of Texas Southwestern Medical School Dallas. Learn about our Medical Review Board Scott Zashin, MD on September 23, 2020 Print Steroid injections, also commonly referred to as cortisone shots, are injections of corticosteroid drugs. The steroid injection can be administered as a localized injection (e.g., intra-articular) or into a muscle (buttocks, for example) or vein for a systemic effect (i.e., whole body). Corticosteroids are synthetic drugs which closely resemble cortisol, a hormone naturally produced by the adrenal glands. By injecting, your doctor can deliver a high dose of corticosteroid medication directly to a painful area of the body for the purpose of decreasing inflammation by reducing immune system activity. saritwuttisan / Getty Images Indications for Steroid Injections Corticosteroids are used to control inflammation in arthritis and other inflammatory conditions. Corticosteroids can be injected directly into inflamed tissues, or they can be delivered to the whole body via oral preparations, intravenous injections, or intramuscular injections. Steroid injections may provide significant relief to patients with arthritis or musculoskeletal conditions. 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 or to enable slower-acting drugs, such as methotrexate or Plaquenil, time to work. The knee is a common joint that is injected. It is recommended that patients limit their weightbearing activity for 1-2 days after an injection to give it the best chance to be effective. Overuse in the first 6 hours after injection can actually aggravate arthritis. Since a local anesthetic is typically combined with the steroid, patients may be unaware that they are putting too much stress on their arthritic joint, as the pain is masked, according to rheumatologist Scott J. Zashin. Recommendations vary, but most physicians will avoid injecting a single joint more than 3 times in a year. For example, you can have your left knee injected two times a year and your right knee injected two times, but not 4 times on the same side. An excessive number or frequency of steroid injections can cause bone, ligament, or tendon damage. There are several options for the steroid drug that is used in an injection. Largely, it depends on the doctors preference (e.g., Depo-Medrol [methylprednisolone acetate], Aristospan [triamcinolone hexacetonide], Kenalog [triamcinolone acetonide] and Celestone [betamethasone]). While patients often feel better immediately in the exam room, once the local anesthetic wears off, it may take up to 10 days to realize that benefit again. Side Effects Most patients receiving steroid injections experience no side effects, especially with adherence to the recommended frequency. However, potential side effects of steroid injections include: increased pain or swelling of the joint in the first 24 hoursswelling, redness, or increased pain after 24 hours (may signal a joint infection)tendon ruptureskin discolorationlocal bleedinginfectionallergic reaction Local steroid injection into the muscle (buttocks) provides a systemic effect. If a specific joint is involved, the steroid injection into the buttocks is likely less effective than an intra-articular injection. As with oral corticosteroids, it is uncertain how much of the systemic medication reaches the specific joint. Also, if the injection into the buttocks is repeated frequently, it can increase the risk of developing some of the common adverse effects experienced with oral steroids, including osteoporosis and cataracts. A Few Important Points Generally, local steroid injections are well-tolerated and less likely to be associated with serious side effects compared to oral corticosteroids.Steroids should not be injected if there is an infection at the site that is to be injected or anywhere in the body.If the affected joint is severely damaged, there is less likelihood for a good outcome with a steroid injection.Typically, it is protocol to aspirate joint fluid for testing purposes before injecting a joint with steroids, especially if the diagnosis is still uncertain. Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Abramowicz S, Kim S, Prahalad S, Chouinard AF, Kaban LB. Juvenile arthritis: current concepts in terminology, etiopathogenesis, diagnosis, and management. Int J Oral Maxillofac Surg. 2016;45(7):801-12. doi:10.1016/j.ijom.2016.03.013 Ferreira JF, Ahmed mohamed AA, Emery P. Glucocorticoids and Rheumatoid Arthritis. Rheum Dis Clin North Am. 2016;42(1):33-46, vii. doi:10.1016/j.rdc.2015.08.006 King W, Miller DC, Smith CC. Systemic Effects of Epidural Corticosteroid Injection. Pain Med. 2018;19(2):404-405. doi:10.1093/pm/pnx173 Freire V, Bureau NJ. Injectable Corticosteroids: Take Precautions and Use Caution. Semin Musculoskelet Radiol. 2016;20(5):401-408. doi:10.1055/s-0036-1594286 Additional Reading Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg. 2017;25(10):703-714. doi:10.5435/JAAOS-D-16-00541