Steroid joint injections

Steroid (also called corticosteroid) injections may be used for treating many different joints including the knee, shoulder, elbow, ankle, wrist and hip. They can be given by your GP, rheumatologist or orthopaedic surgeon. Joint injections may be done at your GP’s surgery, clinic or in a hospital. The steroids used for joint injections are similar to those produced naturally by your body. The mildest is hydrocortisone. Prednisolone, methylprednisolone and triamcinolone are stronger and have longer-lasting effects.

Your pain relief can last for anything from one week to two months or longer, depending on the type of steroid that’s been injected. Some short-acting steroids act quickly (within hours) and may work for at least a week. Other, long-acting steroids may take about a week to start working, but their effects last for a few months. Sometimes a mixture of these may be used. Your doctor or another healthcare professional will discuss with you which is the best option in your circumstances.

The injections can be repeated every three months if you need them. General advice is that joints are injected no more than four times in one year.

Steroid joint injections don’t cure the underlying problem in your joint, but they may ease symptoms and allow you to cope with physiotherapy treatment better.

Your doctor or another healthcare professional will explain how to prepare for your procedure. You may also be given an information leaflet with details about steroid joint injections. There aren’t usually any special preparations you need to make before a steroid a joint injection. Plan to wear comfortable clothing which allows easy access to the affected joint.

The injection may also contain a local anaesthetic, or you may be given a separate injection of local anaesthetic before your steroid injection. This helps to temporarily relieve pain from the area as you have the steroid injection. Ask your doctor or healthcare professional whether you’ll be able to drive after your joint injection. It might be best if you make arrangements beforehand for someone to drive you home.

Your doctor or healthcare professional will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.

Your doctor will examine the area and thoroughly clean the skin over your affected joint with an antiseptic.

They will then inject the steroid. If you're having a local anaesthetic, your doctor may give this as a combined injection with the steroid using a single syringe. Alternatively, you may have two separate injections. For certain joints, such as a hip joint, your doctor may use ultrasound or X-rays during the procedure to help guide the injection into the right spot.

If you have arthritis, you may have too much fluid in your joint, making it feel tight and uncomfortable. If this is the case, your doctor may draw the fluid out with a syringe before your injection. This is known as joint aspiration.

After a local anaesthetic it may take several hours before the feeling comes back into your joint. Take special care not to bump or knock the area.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready. Before you go home, your doctor may assess the movement you have in your joint and give you some exercises to do at home.

If you have had an injection in your spine, you will need someone to drive you home. With other joints, such as your shoulder or knee, you may be ok to drive. Check with your doctor to confirm if you’re able to drive.

You will feel some discomfort as the local anaesthetic wears off. At first, the pain may be worse than before the injection, this is called a ‘steroid flare’.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you're having physiotherapy, your physiotherapist may encourage you to move the joint. Alternatively, you may be advised to keep movements to a minimum for a day or two. It's important to follow your doctor or physiotherapist's advice.

Most people have no problems after steroid joint injections. However, contact your GP if you have a high temperature or persistent swelling, redness or if the pain in your joint doesn't settle within the first couple of days.

As with every procedure, there are some risks associated with steroid joint injections. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of steroid joint injections include:

• an increase in pain and swelling in the injected area – this usually settles within a few days
• thinning or a change in the colour of the skin around the injection site – this tends to be more common with stronger or repeated injections
• a flushed or red face

If you don’t get the right treatment for pre-eclampsia, it may develop into a condition called eclampsia. This happens in one in every 4,000 pregnancies. It can develop at any time during the second half of your pregnancy, during labour or soon after you give birth.

Eclampsia can cause fits (seizures) as a result of pre-eclampsia, which look similar to epileptic fits. If a fit goes on for a long time, both you and your baby may not receive enough oxygen and this can be life-threatening.

Severe pre-eclampsia can also lead to liver, kidney and lung failure and problems with how your blood clots. A combination of all of these serious health problems is called HELLP syndrome. This can also be life-threatening and the only treatment is for you to give birth. This might mean that you have to have your baby early, which can cause other health problems for your baby.aComplications are when problems occur during or after the procedure. Complications of steroid joint injections can include:

• infection – you may need treatment with antibiotics
• damage to nerves or tendons – this is more likely with repeated injections
• changes in the menstrual cycle in women
• changes in your mood or insomnia
• cartilage damage – this tends to be more common with repeated injections

The alternatives to steroid joint injections will depend on what is causing your pain. Alternative treatments include steroid tablets, anti-inflammatory drugs, painkillers and physiotherapy. Speak to your doctor about the options available to you.

1. How often can I have a steroid injection?

Answer
You can have a steroid injection every three months with no more than four injections a year.

Explanation
A steroid injection can be repeated every three months. However, long-term use of steroids can affect your mood, interfere with your menstrual cycle if you're a woman and weaken your bones and muscles. Repeat injections can also damage the joint. For this reason, no more than a maximum of four injections in a year are recommended.

If you still have pain or swelling after a course of steroid injections, speak to your doctor about alternative medical or surgical treatments.

2. Can my child have a steroid joint injection?

Answer
Steroids interfere with growth and are rarely used for children. Steroid injections are sometimes used to relieve pain in certain conditions in under 18s, such as juvenile idiopathic arthritis.

Explanation
Steroids can interfere with bone growth and therefore steroid joint injections are only recommended for people under the age of 18 rarely, for example children with juvenile idiopathic arthritis. Young children or children having several injections may have the steroid injections under general anaesthesia or sedation.

If your child has joint pain or swelling, speak to your doctor about alternative treatments.

3. Can steroid joint injections manage my symptoms over the long term?

Answer
No, steroid injections can't be used long-term.

Explanation
Steroids are used mainly to manage symptoms and not to treat the underlying cause of the condition. For example, the aim of a steroid joint injection is to ease pain and swelling and reduce stiffness so that it's easier to move your affected joint. Steroid joint injections are usually given along with other therapies to help treat or manage the condition causing these symptoms. For example, your doctor will usually recommend physiotherapy to help strengthen the joint area.

Steroids aren't recommended for long-term use because of their effects on the mind and body. For example, they can affect your mood, interfere with your menstrual cycle if you're a woman and weaken the cartilage in your joints.

If you still have pain or swelling after a course of steroid injections, speak to your doctor about alternative treatments.

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Further Information
Arthritis Research
UK0300 790 0400
www.arthritisresearchuk.org

Sources

• Local steroid injections. Arthritis Research UK. www.arthritisresearchuk.org, accessed 28 February 2013
• Joint injection/aspiration. American College of Rheumatology, February 2012. www.rheumatology.org
• Salinas JD. Corticosteroid injections of joints and soft tissues. eMedicine. www.emedicine.medscape.com, published 29 July 2011
• Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
• Joint Formulary Committee. British National Formulary for Children. July 2012. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
• Guideline for the non-surgical management of hip and knee osteoarthritis. The Royal Australian College of General Practitioners, 2009. http://www.racgp.org.au
• Osteoarthritis. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published August 2008