Cortisone Injections into Joints

Report #7296

Orthopedists inject cortisone into joints because they know that these injections can provide immediate dramatic relief of pain and swelling in damaged joints whether from trauma or from inflammatory diseases such as rheumatoid arthritis. However, a major side effect of cortisone is loss of calcium and weakening of bones. Therefore many doctors recommend that a person receive only up to three cortisone injections into a joint during a lifetime.

A study from MIT showed that cortisone-type injections can prevent long-term damage to injured joints (Arthritis Research & Therapy, September 2011).

Damaged cartilage almost never heals and can eventually lead to osteoarthritis. Bones come together to form joints, and the ends of bones are protected by a thick white gristle called cartilage. When you damage cartilage, the outer surface layer in the joint breaks down and the ability to form a new outer layer is markedly reduced, so broken cartilage does not heal. Your joint produces cytokines (TNF, IL-1, and IL-6) that mobilize your immune system to kill invading germs. These same cytokines also attack the broken cartilage to cause even more damage. Cortisone Injections reduce these cytokines, prevent further joint damage, and restore the synthesis of new cartilage to normal levels. Professor Alan Grodzinsky from the MIT Center for Biomedical Engineering said, "Our results suggest that short-term glucocorticoid treatment after joint injury may help restore components of cartilage to pre-injury levels and consequently may prevent the long term changes which lead to osteoarthritis."

However, several earlier studies showed that repeated injections can damage joints and delay healing. For example, scientists in Greece injected cortisone-type drugs repeatedly into the joints of rabbits and showed that they damage cartilage (1). A study in the Journal of Bone and Joint Surgery showed that the injecting cortisone-type medications repeatedly into injured tendons and ligaments delayed healing and weakened tissue (2).

People can be crippled by arthritis and a single injection into a damaged knee joint can allow an arthritic to walk without pain. The same principle applies to athletes and exercisers, who can develop pain in their tendons, muscles, fascia and ligaments from injuries. When injuries heal in a few days, no treatment is indicated, but sometimes they persist for months to cause pain, particularly in the fascia on the bottom or back of the heel, in the large tendon in the back of the lower leg, or in the tendons on the elbows or shoulders. Cortisone-type drugs reduce swelling and lessen pain and can allow an athlete or exerciser to get back to sports, but cortisone injections weaken the tendons for more than three months.

If you suffer chronic pain in the tendons, muscles, ligaments or fascia, check with your doctor to see if you have a chronic disease causing it, such as arthritis or hepatitis. The non-steroidals that are usually prescribed block pain but do not help tissue to heal. Your doctor may prescribe light rehabilitation exercises. If you receive a cortisone-type injection, make sure that you protect that area from hard exercise for at least three months after you receive the injection.

By Gabe Mirkin, M.D., for CBS Radio News



Checked 5/4/12