Cortisone Injections (Steroid Injections)

Painful joint inflammation may be treated with a cortisone injection. Cortisone, a type of corticosteroid, reduces the inflammation associated with conditions such as osteoarthritis, tendonitis, bursitis, rheumatoid arthritis, and gout.

By reducing inflammation, a cortisone injection can alleviate pain, swelling, skin redness, and warmth over the joint. A cortisone injection will not necessarily treat the underlying condition. For example, osteoarthritis and rheumatoid arthritis can be treated, but not cured.

Treating Joint Pain with a Cortisone Injection

A cortisone injection typically relieves inflammation and pain between 6 weeks and 6 months, but results vary widely. The pain may not be relieved at all, return after a few days or longer, or may not recur. It is unclear why results vary and who will respond best.

Temporary pain relief allows the patient to:

• Treat an arthritic flare-up. Cortisone can help treat bouts of severe arthritis pain and symptoms, such as joint pain caused by a gout flare. Similarly, cortisone may be used when rheumatoid arthritis causes persistent swelling in a joint.
• Participate in physical therapy. Pain relief from a cortisone injection can give the patient an opportunity to participate in physical therapy. Prescribed stretching and exercise can improve the affected joint's biomechanics. The hope is that by the time the effects of the cortisone wear off, the joint is healthier and pain is tolerable or even eliminated.
• Postpone surgery. In moderate to severe cases of arthritis, a joint replacement or another surgical treatment may be recommended. For patients who want to postpone or avoid surgery, cortisone injections may allow them to live with less pain.

Patients should have close follow up with an orthopedist or other musculoskeletal specialist for periodic reevaluation. Almost all types of arthritis are chronic, and a cortisone injection is just one part of a larger treatment plan.

Read more about Arthritis Treatment Specialists

Setting Expectations with the Physician

An injection meant to aid in diagnosis can be useful for treating pain, and vice versa. A doctor and patient should take time to discuss the primary purpose of the cortisone injection before it is administered. During this conversation a doctor should let the patient know:

• What part of the joint is being targeted (for example, a joint capsule, bursa, or tendon)
• What are reasonable expectations regarding pain relief
• If follow-up treatment will involve medications, physical therapy, or lifestyle changes

Clear communication and expectations increase the likelihood of successful treatment.

Recognizing Cortisone’s Limitations

While cortisone injections are a valuable treatment, they are not a cure-all and may not work well for everyone. In addition, cortisone, like all medications, can have side effects.

Most notably, cortisone is known to break down tissues, such as articular cartilage in the joint.¹Dragoo JL. Chondrotoxicity of commonly used single injection corticosteroids. Presented at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 15-18. Providence, R.I. Cited by Orthopedics Today. Preservative noted as possible key to intra-articular injection corticosteroid chondrotoxicity. Helio Orthopedics. www.healio.com. Published September 2010. Accessed February 18, 2014.^,2Papacrhistou G, Anagnostou S, Katsorhis T. The effect of intraarticular hydrocortisone injection on the articular cartilage of rabbits. Acta Orthop Scand Suppl. 1997 Oct;275:132-4. PubMed PMID: 9385288.^,3McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283 Cartilage is crucial to joint health, acting as a shock absorber and reducing friction between bones when a person moves. Therefore, most physicians will refuse to administer repeated cortisone injections into the same joint over a short period of time, simply because too much cortisone may cause more harm than good.

Patients are encouraged to learn about cortisone’s potential risks, benefits, and alternatives and to talk to their health care provider about their concerns.