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Cortisone injections into joints

Key points about cortisone injections into joints

Cortisone injections (also called steroid injections) are used for joint problems and arthritis.
They involve the injection of cortisone medication such as triamcinolone, dexamethasone or methylprednisolone directly into a joint space to reduce inflammation (swelling) and pain.
Find out how they are given and possible side effects.

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Cortisone is a substance similar to a natural steroid hormone produced by the body. Cortisone injections are given into a painful joint to reduce pain and swelling in conditions such as gout, rheumatoid arthritis, osteoarthritis, tendinitis, carpal tunnel syndrome and tennis elbow.

Cortisone injections are used when there is a flare-up or the pain in the joint is not responsive to other treatments or when other medications cannot be used. They provide short-term pain relief, usually for up to a month, but do not improve joint function or stiffness.

(RheumInfo, CA, 2019)
Note: this video is from Canada so may have information that differs from New Zealand recommendations. Read more about cortisone injections into joints.

Avoid regular repeated injections

Cortisone injections are used as short-term relief. Regular repeated steroid injections are not recommended. Frequent injections into the same area can cause the bone, ligaments and tendons to weaken over time. Generally, cortisone injections are not given more often than 3 or 4 times a year and they are at least 6 weeks apart.

The following are examples of cortisone injections available in New Zealand:

betamethasone (Celestone Chronodose®)
dexamethasone (DBL Dexamethasone Sodium Phosphate®)
methylprednisolone (Depo-Medrol®)
triamcinolone (Kenacort-A®).

Before giving the cortisone injection, your doctor will remove excess fluid from the joint using a syringe and needle.
The fluid is examined by your doctor and a sample is sent to the laboratory for diagnosis.
Removing the fluid reduces pressure in the joint. This helps relieve pain and may encourage the joint to heal.
A separate syringe and needle are then used to give the cortisone injection.
The cortisone slowly starts to act over 24–36 hours. The beneficial effects may last for days or months.
A local anaesthetic may also be given. This helps relieve pain immediately and lasts for 3 to 4 hours while the cortisone is beginning to take effect.

Care after the injection

After you've had a cortisone injection, rest the joint for about 24 hours and avoid excessive movement or stress on the joint for about 1 week.
Sometimes there is increased pain in the joint after the injection, which settles within 24 hours. To relieve the discomfort rest, apply ice and take pain relievers such as paracetamol (or as advised by your doctor).

Side effects	What should I do?
Flushing Swelling of fingers or face Menstrual irregularity Mood changes	Tell your doctor if troublesome.
Altered colour of the skin at the site of the injection	Discuss with your doctor if this is a concern.
A rise in blood glucose levels for several days following injection	This is a concern for people with diabetes. Tell your doctor.
Signs of infection, such as hot and swollen joint, feeling unwell, fever and pain that does not go away after 48 hours or pain that develops after this time	There is a small risk of infection following a cortisone injection. Infection in a joint can be serious, so it is important to get medical advice as soon as possible if you get any of these symptoms.
Read more about medicines and side effects and reporting a reaction you think might be a side effect.

Gout | Mate waikawa kai kōiwi
Rheumatoid arthritis | Mate rumatiki
Osteoarthritis | Pona ngoikore
Tendinitis
Tennis elbow

The following links have more information on steroid injections. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Steroid injection(external link) Rheuminfo
Celestone Chronodose(external link) Medsafe Consumer Information, NZ
Kenacort-A(external link) Medsafe Consumer Information, NZ
Local steroid injections Arthritis Research, UK
Steroid Injections(external link) Patient Info, UK
Joint injections (joint aspirations)(external link) American College of Rheumatology, US