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What is it about ?
Cortisone is a potent anti-inflammatory drug given orally (eg as a tablet) or by injection (eg as an infiltration).
For a general effect, the injection is given into the veins or into the buttock. For a local effect, in tendon attachments, bursae and joints. The great advantage of local injections is that it is possible to use low doses. The risk of general side effects is therefore lower. In addition, the product is administered where its effect is needed.
We mainly use 3 products: methylprednisolone, triamcinolone and betamethasone. They differ mainly in their strength and duration of action. The effect of methylprednisolone is only short-lived. Triamcinolone is as potent as methylprednisolone, but the duration of action is much longer. Betamethasone is about five times more potent than triamcinolone.
Sometimes the cortisone preparation is mixed with a local anesthetic. This combination provides immediate pain relief. The downside is that anesthetic fluids may contain a preservative which can cause allergic reaction.
Cortisone injections are usually given a maximum of 4 times a year.
When is a cortisone injection indicated?
Cortisone injections are indicated for various pathologies, including inflammation of a joint (arthritis), a tendon (tendonitis) or a bursa (bursitis).
For more details, read below ‘What can your doctor do?’
What can you do ?
After an injection of cortisone into the joint, it is important to let the joint rest and not to strain it intensely for the first week. No sport therefore. This rest improves the outcome of the treatment, at least for the large joints.
You may have a little more pain in your joint the same day. To relieve the pain, you can take paracetamol.
In rare cases, an infection may develop at the injection site. Contact the doctor immediately if you have a fever associated with redness, warmth and swelling at the injection site.
What can your doctor do?
The decision to give a cortisone injection depends on the nature of the condition and the risk of side effects.
An injection of cortisone gives:
- excellent results in the following situations:
- certain joints of the fingers and toes,
- knee effusion,
- swelling of the elbow,
- gout in the big toe,
- bursitis with effusion,
- certain shoulder problems,
- good results in the following situations:
- some tendonitis,
- inflammation of the sole of the foot,
- wrist,
- jaw,
- acute flare-up of polyarthritis,
- hip bursitis (trochanteric bursitis).
- poor results in the following situations:
- knee osteoarthritis without effusion
- lateral epicondylitis
- wrist joint cyst.
When in the case of osteoarthritis of the knee, the injected cortisone does not work or if, for a specific reason, it is not allowed to inject cortisone, the doctor can inject hyaluronic acid in case osteoarthritis of the knee. In some, hyaluronic acid relieves symptoms to some extent. But the balance between benefit and risk is unclear.
The doctor never gives a cortisone injection in the following situations:
- joint inflammation due to infection,
- when the skin at the injection site is unhealthy, such as eczema or skin infection,
- prosthesis,
- poor arterial circulation in the injection area.
One of the rare but serious side effects is necrosis of the femoral head (aseptic necrosis). The doctor will take this into account before deciding whether or not to inject cortisone into the hip joint.
Want to know more?
- Corticosteroids – CBIP – Belgian Center for Pharmacotherapeutic Information
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
Sources
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