We use cortisone for many diseases, such as allergies, autoimmune disorders, skin diseases, and musculoskeletal conditions. This drug can be given as tablets, liquid, nasal spray, or injections. It also has many potential side effects depending on the dose, duration of use, and how it is given. So, do cortisone shots cause weight gain and other side effects, and how do we prevent these side effects?
What is cortisone?
Cortisone is a synthetic derivative of a naturally occurring drug called cortisol. The adrenal glands above the kidneys produce cortisol to regulate and control many body processes including inflammation, hormones, body temperature, and the immune system. Taking cortisone has a powerful effect on reducing inflammation and regulating the immune system.
What are cortisone shots used for?
Cortisone shots are used for musculoskeletal arthritis (such as osteoarthritis or inflammatory arthritis) or tendonitis. Examples of common conditions include Achilles tendonitis, jumper’s knee, rotator cuff tendonitis, and knee and hip osteoarthritis.
Is there a difference between cortisone shots and tablets?
Yes. Cortisone tablets such as prednisolone are often taken by mouth and given to treat serious conditions such as lupus, severe eczema, and multiple sclerosis. However, the drug is used at high doses and for a long duration. The drug is absorbed by the gut and enters the circulation, affecting the whole body. As such, it also has the potential to produce many side effects, such as weight gain and insomnia. In addition, it can suppress the production of cortisol in the adrenal glands causing Addison’s disease.
However, most steroids used for the musculoskeletal system are given as cortisone shots. These shots provide a high concentration of cortisone in a localised area such as a joint, bursa, or tendon sheath. Therefore, little cortisone is absorbed systematically, which reduces many side effects. Also, after 4-6 weeks, we expect all the cortisone from one shot to be eliminated from the body.
So, do cortisone shots cause weight gain?
As a general rule – no. The amount of cortisone absorbed by the body is minimal after a single cortisone shot for joint or tendon problems. Moreover, a few cortisone injections over 3-6 months are unlikely to produce severe side effects such as weight gain. Compare this effect to long-term tablets. In a recent study, high-dose oral tablets over two years caused at least a 5% weight gain.
Side effects of cortisone shots for musculoskeletal conditions
While a cortisone shot does not cause weight gain, we must be aware of local side effects. These adverse effects include:
- Cortisone flare: This reaction is common 12-24 hours after local cortisone shot and can last up to a week. Treatment includes rest from activity, ice, and topical and oral anti-inflammatories.
- Skin colour changes: Cortisone injected just under the skin can reduce the pigmentation the skin produces, leading to a colour change. While the effect is not permanent, it can take months or years to settle, particularly in dark-skinned people.
- Fat atrophy: While oral tablets can cause you to put on more fat, localised injections cause fat shrinkage, also called fat atrophy. This effect causes a dimpling of the skin, which may look cosmetically unappealing.
- Tendon rupture: Recent evidence suggests that a localised cortisone shot can cause the weakening of tendons, increasing the risk of rupture. This effect is most pronounced in the first six weeks after injection.
- Infection: A cortisone shot can increase the risk of infection by altering the immune cells around the area injected. We can reduce this risk using a strict sterile technique, including sterile gloves and dressing packs.
- Damage to articular cartilage: Recent evidence suggests that repeated cortisone shots into a joint could decrease articular cartilage volume. We should be cautious about repeated injections into one joint.
- Increase in blood sugar: A cortisone shot can increase blood sugar for 2-4 weeks. This effect is pronounced in people who are diabetics. Therefore, we should be cautious about cortisone injections in unstable diabetes.
- Facial flushing: Some people develop a pronounced facial flush, which starts about 2-4 hours after an injeciton and lasts up to 24 hours. It can also happen with future cortisone shots.
Other commonly asked questions related to: Do cortisone shots cause weight gain?
How long does it take for a cortisone shot to work?
Generally, a cortisone shot takes 4-5 days to start working. However, we often say you should leave about a week before an event for the cortisone shot to work. Also, you must be aware that cortisone can cause a flare of pain in the first few days. Therefore, you must rest for a few days after the cortisone shot to prevent the flare from worsening.
How long do cortisone shots last?
The effect of a cortisone shot can last from six weeks to six months. As cortisone reduces inflammation, it can make you feel great. However, this effect is temporary, as cortisone does not cure the disease. Nevertheless, this window of pain relief can help with rehab.
Are cortisone shots better under ultrasound?
Yes. There is good evidence that ultrasound guidance improves the accuracy and effect of a cortisone shot. Guidance also reduces the side effects such as skin changes and fat trophy. If you are thinking about a cortisone shot, you should see a doctor with experience in ultrasound-guided injections. Unfortunately, not all practitioners performing injections are qualified. See this blog for the top 4 questions to ask before you have an ultrasound-guided injection.
Final word from Sportdoctorlondon: Do cortisone shots cause weight gain?
Cortisone shots concentrate the drug in the injected area, such as the tendon, joint, or bursa. So, systemic side effects such as weight gain are not common. However, local side effects, including skin depigmentation and fat atrophy, are. Therefore, you should see a doctor with injeciton experience to prevent side effects. Dr Masci has 15 years of experience in ultrasound and ultrasound-guided injections, including cortisone, PRP, and hyaluronic acid.
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