Corticosteroids (intra-articular) for osteoarthritis

Examples

Injected

Generic Name	Brand Name
betamethasone	Celestone
methylprednisolone	Depo-Medrol
triamcinolone	Aristospan, Kenalog

Intra-articular corticosteroids or steroids are medicines injected directly into the joint space of a painful, inflamed arthritic joint. Steroids taken by mouth (orally) are not used for osteoarthritis.

How It Works

Steroids are similar to natural substances produced by the body (hormones) that help reduce inflammation. If inflammation is not a symptom of your osteoarthritis, steroids are less likely to be helpful.

Steroids may be used to reduce inflammation in tendons and ligaments in osteoarthritic joints.

Why It Is Used

If a person has not improved with treatment using analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs), an injection of corticosteroid into the joint can sometimes be helpful for short-term pain relief.

How Well It Works

Corticosteroids may relieve pain caused by osteoarthritis for a short amount of time (weeks to months).¹

If corticosteroid injections are helpful, symptoms may improve for weeks to months. Some people get long-term relief of 6 months or more with a single cortisone shot. If you have a moderate amount of fluid in the joint, your chances of responding are probably better.

Side Effects

Corticosteroids are used with caution because of potential side effects. Side effects may include:

• Increased pain the first day or two after a corticosteroid injection. Applying ice at home for 15 to 20 minutes after the injection may help reduce pain.
• Tendon weakening and scarring, causing loss of strength and movement and potential for tendon rupture.
• Accidental nerve injury during injection.
• Skin color (pigmentation) changes.
• Dimpling of the skin (subcutaneous atrophy).
• Infection.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Common short-term side effects include:

• Mood swings.
• Nervousness.
• Insomnia.
• Weight gain.
• Fluid retention.
• Very rounded (moon) face.
• Poor wound healing.
• Increased risk of infection.
• High blood pressure.
• Diabetes.

Uncommon short-term side effects include:

• Muscle weakness.
• Glaucoma.
• Stomach ulcers.
• Acne.

Long-term side effects include:

• Osteoporosis.
• Cataracts (uncommon).
• Damage to the hip, shoulder, or knee joints (uncommon).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

There are several issues to think about with steroid injections for osteoarthritis.

The standard of practice is that steroid injections should be given only 3 or 4 times a year in a single joint area.

A small study suggests that injections every 3 months for up to 2 years is safe and effective in reducing symptoms of osteoarthritis.²

Injection of any substance into a joint or tendon has a very small risk of harm, including damage to a tendon, ligament, or nerve; bleeding into the tissue; or infection. Although these rarely happen, your doctor will probably mention the possibilities to you before an injection into a joint.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: April 17, 2009
Medical Review:	Anne C. Poinier, MD - Internal Medicine Richa Dhawan, MD - Rheumatology
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