Are Cortisone Injections Bad for You? Debunking the Myths

Over 500000 cortisone injections are performed for musculoskeletal conditions such as arthritis and tendonitis. Although cortisone effectively reduces inflammation in these conditions, it often gets a bad rap. So, are cortisone injections bad for you?  

What is cortisone? 

Cortisone is a powerful anti-inflammatory drug. It has been used to reduce inflammation in musculoskeletal and immune conditions (such as rheumatoid arthritis). Moreover, cortisone has many other effects, some of which we haven’t defined clearly. So, it’s a drug that needs to be respected.

Your body makes corticosteroids naturally through the adrenal glands on top of your kidneys. Cortisone is a synthetic or manufactured corticosteroid that mimics the effect, including reducing inflammation and maintaining blood pressure and sugar levels.

It is important to note that cortisone is not the same as anabolic steroids, which build muscle but do not reduce inflammation. 

Pros

Generally, when we think about tendonitis and arthritis, these conditions have inflammation. To reduce inflammation, we can take medication by mouth (such as cortisone or ibuprofen tablets). However, taking medication by mouth distributes a small amount throughout the body and may increase side effects.

On the other hand, a cortisone injection targets this powerful drug directly to the inflammation spots. Therefore, there is less absorption of the drug throughout the body.

In general, we recommend a cortisone injection for those conditions that are more inflammatory. These conditions include trigger finger and De Quervain’s tenosynovitis.

However, inflammation plays less of a role in conditions such as tendonitis, with degeneration being more critical. As such, cortisone injections are less effective. Examples include tennis elbow, Achilles tendonitis, and patellar tendonitis. Cortisone injections may worsen the pain at three months in some tendons, such as tennis elbow. Therefore, overall, we should use cortisone less for tendonitis.

Similarly, in conditions such as knee osteoarthritis, the results of a cortisone injection are less than what we want. For example, recent studies suggest cortisone injections for knee arthritis relieve mild pain lasting only about three months. However, there is some concern that repeated cortisone injections may accelerate arthritis.

Cons 

Cortisone injections administer a high concentration into an area with a low concentration in the body. Thus, we are concerned that this high concentration can have nasty side effects. These side effects are for both tendons and joints.

For example, recent studies show that repeated cortisone injections into joints can soften and increase cartilage damage. One study found that you had twice the chance of suffering from cartilage damage after a cortisone injection compared to other drugs. This damage may not be a concern for older patients where the damage has already been done. However, for younger patients, cartilage softening is not so good.

For tendons, we know that cortisone reduces the mechanical strength of diseased tendons, particularly in the first few weeks after injection. To mitigate this risk, we suggest you rest your injected tendon from activity such as running for 10-14 days. You should ask your doctor about activity after a cortisone injection to your tendon.

In addition, there are other side effects of cortisone that we need to avoid. For example, cortisone injected close to the skin can lead to skin thinning, fat shrinking, and reduced pigmentation. So, overall, we need to be careful when injecting cortisone close to the skin. Other potential side effects from cortisone include increased sugar levels, a cortisone flare lasting 3-5 days after injection, an increased risk of infection, and facial flushing. 

Are cortisone injections bad for you? Other cortisone myths debunked: 

You can only have three cortisone injections in a lifetime

Generally, if the first injection doesn’t work, the second and third probably won’t either. Moreover, you should limit yourself to 2-3 injections in one area over 3-6 months. However, the rule that you can only have three in a lifetime is invalid. You can have injections into different parts of the body.

Cortisone injections will weaken my bones and make me fat

As discussed above, the amount of cortisone moving throughout your body after an injection is tiny. The cortisone is usually cleared from your body after a week or two. So, we don’t think you should be too concerned about weak bones or weight gain.

Why am I having a cortisone injection if it’s just a painkiller?

Cortisone helps with pain. But it also reduces inflammation and treats the problem rather than just masking it. However, the key is only to use cortisone safely for particular conditions.

Does a cortisone injection weaken the immune system?

Cortisone is a potent anti-inflammatory. However, it also suppresses the immune system. Studies suggest that this effect only lasts for a few weeks. There is no evidence that one or two cortisone shots have long-term effects on the immune system. 

Is there an alternative to cortisone injections? 

Yes. Given some concerns about cortisone, we try to use alternatives for some conditions. 

Hyaluronic acid

Hyaluronic acid is a naturally occurring substance in joints, bones, and tendons. We use hyaluronic acid for arthritis and some cases of tendonitis. Recent evidence suggests that hyaluronic acid reduces pain longer than cortisone with less nasty side effects.

Different types of hyaluronic acid are separated by the size of the hyaluronic acid molecule – either high or low molecular weight. Generally, we think that high molecular weight hyaluronic acid, such as Durolane, is more potent and lasts longer. For example, one study showed that Durolane – a type of high molecular weight hyaluronic acid – lasts up to 15 months after one injection. Also, repeated injections showed the same improvement for up to 5 repeated injections.

However, like any injection, there is a small risk of side effects such as joint pain and swelling. Generally, about 10-20% of injections lead to a small amount of pain and swelling.

PRP

Platelet-rich plasma, or PRP, is used for some cases of tendinitis and arthritis. Platelet-rich plasma comes from whole blood. We spin the blood in a centrifuge, separating the cells from the plasma. This plasma contains a high concentration of platelets, which have growth factors. We inject this plasma into joints and tendons to improve healing and reduce inflammation.

Recent studies suggest that PRP effectively reduces pain in knee arthritis, plantar fasciitis, tennis elbow, greater trochanteric pain syndrome, and rotator cuff pain.

Combined PRP and hyaluronic acid

Perhaps combining the two is better than just the one. Indeed, recent evidence suggests that a combined PRP and hyaluronic acid is better than PRP alone for knee arthritis. This positive effect occurs at 3. 6, and 12 months.

Arthrosamid injeciton for knee arthritis 

Arthrosamid is a unique hydrogel of water molecules attached to a polyacrylamide backbone. The injectable is non-degradable, meaning the body does not break it down.

It works by coating the lining of the synovium of the knee joint, reducing inflammation, and providing lubrication.

Recent studies show improvement in pain scores lasting for up to 2 years. In addition, compared to hyaluronic acid, it works better in younger and slimmer patients.

Final word from Sportdoctorlondon: So, are cortisone injections harmful to you? 

So, are cortisone injections bad for you? In general, we think that cortisone injections can still be used safely for some conditions. However, we use cortisone less for many diseases and substitute it for other injections such as hyaluronic acid and PRP. It would be best to ask your doctor about these options to find the best one. Finally, you should see a doctor who has experience in ultrasound-guided injections.

Dr. Masci is an expert in ultrasound and ultrasound-guided injections, including cortisone, hyaluronic acid, PRP, and Arthrosamid.  

Related topics:

• Platelet-rich plasma for arthritis and tendonitis
• Hyaluronic acid injections
• Arthrosamid for knee arthritis
• Combining PRP and hyaluronic acid for knee arthritis
• How long does it take for a cortisone shot to work? FAQ
• How long does a steroid shot last?
• Do you need to rest after a cortisone injection? 
• Do cortisone shots cause weight gain? 
• Cortisone and diabetes: what should you do? 
• Can you have a cortisone shot while pregnant? 
• Cost of cortisone injections