Cortisone shots – Mayo Clinic

Overview

Cortisone shots are injections that can help relieve pain and inflammation in a specific area of your body. They’re most commonly injected into joints — such as your ankle, elbow, hip, knee, shoulder, spine or wrist. Even the small joints in your hands or feet might benefit from cortisone shots.

The injections usually contain a corticosteroid medication and a local anesthetic. Often, you can receive one at your doctor’s office. Because of potential side effects, the number of shots you can get in a year generally is limited.

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Why it’s done

Cortisone shots might be most effective in treating inflammatory arthritis, such as rheumatoid arthritis. They can also be part of treatment for other conditions, including:

• Back pain
• Bursitis
• Gout
• Osteoarthritis
• Psoriatic arthritis
• Reactive arthritis
• Rheumatoid arthritis
• Tendinitis

Risks

Potential side effects of cortisone shots increase with larger doses and repeated use. Side effects can include:

• Cartilage damage
• Death of nearby bone
• Joint infection
• Nerve damage
• Temporary facial flushing
• Temporary flare of pain and inflammation in the joint
• Temporary increase in blood sugar
• Tendon weakening or rupture
• Thinning of nearby bone (osteoporosis)
• Thinning of skin and soft tissue around the injection site
• Whitening or lightening of the skin around the injection site

Limits on the number of cortisone shots

There’s concern that repeated cortisone shots might damage the cartilage within a joint. So doctors typically limit the number of cortisone shots into a joint.

In general, you shouldn’t get cortisone injections more often than every six weeks and usually not more than three or four times a year.

How you prepare

If you take blood thinners, you might need to stop taking them for several days before your cortisone shot to reduce bleeding or bruising risk. Some dietary supplements also have a blood-thinning effect. Ask your doctor what medications and supplements you should avoid before your cortisone shot.

Tell your doctor if you’ve had a temperature of 100.4 F (38 C) or greater in the previous two weeks.

What you can expect

During the cortisone shot

Your doctor might ask you to change into a gown. You’ll then be positioned so that your doctor can easily insert the needle.

The area around the injection site is cleaned. Your doctor might also apply an anesthetic spray to numb the area where the needle will be inserted. In some cases, your doctor might use ultrasound or a type of X-ray called fluoroscopy to watch the needle’s progress inside your body — so as to place it in the right spot.

You’ll likely feel some pressure when the needle is inserted. Let your doctor know if you have a lot of discomfort.

The medication is then released into the injection site. Typically, cortisone shots include a corticosteroid medication to relieve pain and inflammation over time and an anesthetic to provide immediate pain relief.

After the cortisone shot

Some people have redness and a feeling of warmth of the chest and face after a cortisone shot. If you have diabetes, a cortisone shot might temporarily increase your blood sugar levels.

After your cortisone shot, your doctor might ask that you:

• Protect the injection area for a day or two. For instance, if you received a cortisone shot in your shoulder, avoid heavy lifting. If you received a cortisone shot in your knee, stay off your feet when you can.
• Apply ice to the injection site as needed to relieve pain. Don’t use heating pads.
• Not use a bathtub, hot tub or whirlpool for two days. It’s OK to shower.
• Watch for signs of infection, including increasing pain, redness and swelling that last more than 48 hours.

Results

Results of cortisone shots typically depend on the reason for the treatment. Cortisone shots commonly cause a temporary flare in pain and inflammation for up to 48 hours after the injection. After that, your pain and inflammation of the affected joint should decrease, and can last up to several months.

Cortisone Injection Risks and Side Effects

Arthritis and other joint problems may be treated with cortisone injections. Like any treatment, these injections carry certain risks and side effects. Most are mild or temporary, but some can be serious or long-lasting.

Patients are advised to discuss concerns about risks and side effects with their health care providers before receiving cortisone injections. Potential risks and side effects include:

Pain and Swelling (Cortisone Flare)

The injected cortisone medication can crystallize inside the body. The crystals can cause pain and inflammation that is worse than the pain and inflammation caused by the condition being treated. This side effect is called a cortisone flare. A flare typically lasts one or two days and can be treated with rest and intermittent cold packs.

See When and Why to Apply Cold to an Arthritic Joint

Skin Discoloration

Patients may notice the skin around the injection site changes color a few weeks or months after the injection.^1,2 This side effect is most common in darker-skinned patients, who notice the skin becomes lighter.¹

Skin discoloration may last a few weeks or months or be permanent.² Skin discoloration is not harmful to patients’ health. This side effect occurs in 1.3% to 4% of patients³ and seems to be related to the type and concentration of corticosteroid medication used.^1,2

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Fat Atrophy

A cortisone injection may cause fat cells at the injection site to atrophy. A divot or depression in the skin may appear because the underlying fat cells have deteriorated. The skin’s appearance usually goes back to normal in 6 months but may take 2 or 3 years.² Authors of one study estimate this side effect occurs in 0.6% (6 out of every 1000) injections.⁴

Elevated Blood Sugar

In addition to decreasing inflammation, corticosteroids can raise blood sugar levels. A patient with diabetes should inform their doctor prior to receiving an injection and then closely monitor blood sugar levels for a day or two following a cortisone injection.

The injection does not deliver cortisone directly to the bloodstream, but it can still influence blood sugar levels in some patients.

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Tendon Injury

Cortisone injections can weaken nearby tendons and make them more prone to tearing.⁵ Because of this risk, physicians take precautions to avoid placing a cortisone injection in or directly next to a tendon.

Patients can reduce their risk of tendon injuries by resting the affected joint for a few days after the injection and then gradually increasing activity with recommended stretching and exercises.

Cartilage Loss

Research suggests cortisone injections may have a negative effect on cartilage. For example, one study⁶ found an association between repeated cortisone injections and 0.11 cm loss of cartilage in the knee. The same study did not find an association with increased knee pain.

Infection

Though rare,^7,8 infection is a serious potential side effect. People who are more prone to infection, such as those who have autoimmune diseases and who take immune-suppressing medications, should inform their health care provider. After receiving a cortisone injection, any patient who suspects an infection or runs a fever is advised to contact their doctor.

Allergic Reaction

Patients should tell their doctor if they have ever had an allergic reaction following an injection. While uncommon, some patients have allergic reactions to the local anesthetic added to the injection. Allergic reactions to the cortisone itself are rare because cortisone is a synthetic version of cortisol, a steroid naturally found in the body.

Sex-Related Side Effects

While not common, women may experience⁹:

• Irregular menstruation
• Disturbances in lactation, if the woman is breast-feeding
• Skin flushing
• Excess hair growth

Unlike women, men do not seem to experience any unique side-effects.⁹

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Doctors do not recommend cortisone injections for patients who have an existing infection, including skin infections and septic arthritis. In addition, cortisone injections may not be appropriate for patients who are taking blood thinners or who have broken bones.

Some patients may be concerned about weight gain and water retention from corticosteroid use. However, these side effects are common only for patients who take corticosteroid medications orally for an extended period of time. These side effects rarely occur when the cortisone medication is injected into a joint.

See What Is Cortisone?

Read more articles about other types of injections in the Injections Health Center

References

• 1.Gupta A, Garg M, Johnson N, Vignesh P. Hypopigmentation after intra-articular corticosteroid injection. BMJ Case Rep. 2019 Mar 31;12(3). doi: 10.1136/bcr-2018-228921. PubMed PMID: 30936358.
• 2.Park SK, Choi YS, Kim HJ. Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection. Korean J Anesthesiol. 2013;65(6 Suppl):S59–S61. doi:10.4097/kjae.2013.65.6S.S59
• 3.Newman RJ. Local skin depigmentation due to corticosteroid injection. Br Med J (Clin Res Ed) 1984;288:1725–1726. As cited in Park SK, Choi YS, Kim HJ. Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection. Korean J Anesthesiol. 2013;65(6 Suppl):S59–S61. doi:10.4097/kjae.2013.65.6S.S59
• 4.Newman RJ. Local skin depigmentation due to corticosteroid injection. Br Med J (Clin Res Ed) 1984;288:1725–1726. As cited in Park SK, Choi YS, Kim HJ. Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection. Korean J Anesthesiol. 2013;65(6 Suppl):S59–S61. doi:10.4097/kjae.2013.65.6S.S59
• 5.Kleinman M, Gross AE. Achilles tendon rupture following steroid injection: report of three cases. J Bone Joint Surg Am. 1983; 65(9):1345-1347. As cited in Brook EM, Hu CH, Kingston KA, Matzkin EG. Corticosteroid Injections: A Review of Sex-Related Side Effects. Orthopedics. 2017 Mar 1;40(2):e211-e215. doi: 10.3928/01477447-20161116-07
• 6.McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283
• 7.McGarry JG, Daruwalla ZJ. The efficacy, accuracy and complications of corticosteroid injections of the knee joint. Knee Surg Sports Traumatol Arthrosc. 2011 Oct;19(10):1649-54. doi: 10.1007/s00167-010-1380-1. Epub 2011 Jan 11. Review. PubMed PMID: 21222099.
• 8.Pal B, Morris J. Perceived risks of joint infection following intra-articular corticosteroid injections: a survey of rheumatologists. Clin Rheumatol. 1999;18(3):264-5. doi: 10.1007/s100670050098. PubMed PMID: 11206357.
• 9.Brook EM, Hu CH, Kingston KA, Matzkin EG. Corticosteroid Injections: A Review of Sex-Related Side Effects. Orthopedics. 2017 Mar 1;40(2):e211-e215. doi: 10.3928/01477447-20161116-07

Cortisone Uses, Side Effects & Warnings

Generic name: cortisone (KOR ti sone)
Brand name: Cortone Acetate
Dosage forms: oral tablet (25 mg)
Drug class: Glucocorticoids

Medically reviewed by Drugs.com on June 7, 2021. Written by Cerner Multum.

What is cortisone?

Cortisone is a steroid medicine that is used to reduce inflammation caused by many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing problems.

Cortisone may also be used for purposes not listed in this medication guide.

Warnings

Follow all directions on the label and package. Use exactly as directed.

Before taking this medicine

You should not use cortisone if you are allergic to it, or if you have a fungal infection anywhere in your body.

Steroids can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have. Tell your doctor about any illness or infection you had within the past several weeks, especially:

Tell your doctor if you have ever had:

Tell your doctor if you are pregnant or breastfeeding.

How should I take cortisone?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Your dose needs may change due to surgery, illness, stress, fever, or infection. Do not change your dose or stop using cortisone without your doctor’s advice.

cortisone can affect the results of certain medical tests. Tell any doctor who treats you that you are using cortisone.

Store at room temperature away from moisture, heat, and light.

Wear a medical alert tag or carry an ID card to let others know you take steroid medicine.

You should not stop using cortisone suddenly. Follow your doctor’s instructions about tapering your dose.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

High doses or long-term use of steroid medicine can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while taking cortisone?

Ask your doctor before receiving a vaccine. The vaccine may not work as well while you are using cortisone.

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using cortisone.

Avoid drinking alcohol.

Cortisone side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• blurred vision, eye pain or redness, seeing halos around lights;

• swelling, rapid weight gain, feeling short of breath;

• unusual changes in mood or behavior;

• skin lesions;

• sudden unusual pain in a bone or joint;

• severe headaches, ringing in your ears, pain behind your eyes;

• stomach bleeding–bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

• pancreatitis–severe pain in your upper stomach spreading to your back, nausea and vomiting; or

• low blood potassium–leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Cortisone can affect growth in children. Tell your doctor if your child is not growing at a normal rate.

Common side effects may include:

• high blood pressure;

• muscle pain or weakness;

• sleep problems (insomnia), mood changes;

• thinning skin, bruising or discoloration;

• increased sweating;

• headache, dizziness, spinning sensation;

• stomach pain, bloating; or

• slow wound healing.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect cortisone?

Tell your doctor about all your other medicines, especially:

This list is not complete. Other drugs may affect cortisone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Does Cortisone interact with my other drugs?

Enter other medications to view a detailed report.

Frequently asked questions

More about cortisone

Professional resources

Related treatment guides

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Copyright 1996-2021 Cerner Multum, Inc. Version: 8.01.

Cortisone – Drug Information – Chemocare

Chemocare.com

Care During Chemotherapy and Beyond

Generic Name: Hydrocortisone
Trade Names: Ala-Cort
®, Hydrocortone
Phosphate,  Solu-Cortef ^®, Hydrocort Acetate ^®, Lanacort ^®
Other Names: Hydrocortisone
Sodium Succinate, Hydrocortisone Sodium
Phosphate

Drug Type:

Cortisone has many uses in the treatment of cancer and is used most often as a supportive
care medication. Cortisone is classified as a glucocorticosteroid.  (For more
detail, see “How Cortisone Works” section below).

What Cortisone Is Used For:

• Cortisone is used as an anti-inflammatory medication.  Hydrocortisone relieves
  inflammation in various parts of the body.
• Cortisone is used to treat or prevent allergic reactions.
• Cortisone is used as treatment of certain kinds of autoimmune diseases, skin conditions,
  asthma and other lung conditions.
• Cortisone is used as treatment for a variety of cancers, such as leukemia, lymphoma,
  and multiple myeloma.  
• Cortisone is used to treat nausea and vomiting associated with some chemotherapy
  drugs.
• Cortisone is used to stimulate appetite in cancer patients with severe appetite
  problems.
• The lotion (topical) is used in treatment of allergic skin reactions, and relieves
  symptoms of itching, redness, and swelling.  
• Cortisone is also used to replace steroids in conditions of adrenal insufficiency
  (low production of needed steroids produced by the adrenal glands).

If a drug has been approved for one use, physicians sometimes
elect to use this same drug for other problems if they believe it might be helpful.

How Cortisone Is Given:

• Cortisone may be given to you in many forms. In a pill form, it is available in
  5 mg, 10 mg, and 20 mg tablets. If you are on a daily dose of hydrocortisone, and
  you miss a dose, take the dose as soon as you remember. You may be instructed to
  repeat the missed dose, and continue the medication.
• Take pills with food or after meals.
• Cortisone may also be given by injection into the muscle (intramuscular, IM) or into
  the vein (intravenously, IV), by a healthcare provider.  
• Hydrocortisone eye ointment, or eye drops, is given to treat or prevent many inflammatory
  eye conditions. 
• You may be given hydrocortisone as a lotion or a cream (topical) to treat skin disorders.
• The amount of hydrocortisone you will receive depends on many factors, including
  your height and weight, your general health or other health problems, and the reason
  you are receiving Cortisone.  Your doctor will determine your exact dosage
  and schedule.

Cortisone Side Effects:

Important things to remember about the side effects of hydrocortisone include:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration. 
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.

The following side effects are common (occurring in greater than 30%) for patients
taking hydrocortisone:

The following are less common side effects (occurring in 10 to 29%) for patients
receiving hydrocortisone:

• Headaches
• Dizziness
• Mood swings
• Cataracts and bone thinning (with long-term use)

This list includes common and less common side effects for individuals taking hydrocortisone. 
Side effects that are very rare, occurring in less than 10% of patients, are not
listed here.  However, you should always inform your health care provider if
you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100. 4° F (38° C), chills (possible signs of infection)
• If you feel an irregular or fast heartbeat, shortness of breath, or chest or jaw
  pain, seek emergency help and notify your healthcare provider.
• If you become suddenly confused

The following symptoms require medical attention, but are not emergency situations. 
Contact your health care provider within 24 hours of noticing any of the following:

• Extreme fatigue (unable to carry on self-care activities)
• Any unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Nausea (interferes with ability to eat and unrelieved with prescribed medications)
• Vomiting (vomiting more than 4-5 times in a 24-hour period)
• Dizziness or lightheadedness, feeling faint
• Persistent headache
• Severe hot flashes or mood swings
• Inability to sleep (insomnia)
• Severe skeletal (bone) pain
• Difficult or painful urination; increased urination, or severe thirst
• Changes in vision, blurred vision, eye pain, enlarged pupils, discharge
• Any new rashes or changes in your skin
• Swelling of the feet or ankles.   Sudden weight gain (greater than 3 pounds
  a week)
• Swelling, redness and/or pain in one leg or arm and not the other

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting hydrocortisone treatment, make sure you tell your doctor about any
  other medications you are taking (including prescription, over-the-counter, vitamins,
  herbal remedies, etc.).   Do not take aspirin, or products containing
  aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor’s approval
  while taking hydrocortisone.
• If you have been on hydrocortisone pills daily, for a long period of time, serious
  side effects may occur if you discontinue the medication abruptly. Do not stop taking
  Cortisone unless directed by your healthcare provider. Do not change the dose of
  hydrocortisone on your own.
• Inform your health care professional if you are pregnant or may be pregnant prior
  to starting this treatment.  Pregnancy category C (use in pregnancy only when
  benefit to the mother outweighs risk to the fetus). 
• For both men and women: Do not conceive a child (get pregnant) while taking hydrocortisone.
  Barrier methods of contraception, such as condoms, are recommended. Discuss with
  your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking Cortisone.

Self-Care Tips:

• If you are on Cortisone for a long period of time, you may be more susceptible to
  infection. Wash your hands well, and report any symptoms of infection to your healthcare
  provider if noted.
• If you are given eye drops or eye ointment: You may be more sensitive to the light.
  Wearing sunglasses may help. It is normal to notice a little blurriness for a short
  time after the drops or ointment are placed in your eyes. Notify your healthcare
  provider with any changes in vision, blurriness, or eye pain.
• If you are given eye drops or eye ointment: Ask your healthcare provider if you
  may wear contact lenses. Contact lenses may absorb the medication. Wash your hands
  well before putting eye drops, to decrease the chance of a bacterial infection in
  your eyes. 
• If you are hydrocortisone as a lotion (topical) to treat skin disorders: Do not
  apply to open areas of skin, or if you have open or weeping sores. Topical hydrocortisone
  should not be used for a long time. Discuss this with your healthcare provider.  
• Certain brands of hydrocortisone can be applied to the rectal area to treat hemorrhoids,
  or local inflammation, either by a suppository of ointment. Make sure that the preparation
  that you are using was made specifically for the rectal area. 
• In a pill form: Take Cortisone with food to lessen an upset stomach. Also take Cortisone
  early on in the day (before 12:00 noon, if possible), so you will be able to sleep
  better at night.
• If you have diabetes, Cortisone may increase your blood sugar levels. Notify your
  healthcare provider that you are diabetic. You may need close monitoring. Drink 2
  to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid
  intake, and maintain good nutrition. 
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
  eat small, frequent meals.
• In general, drinking alcoholic beverages should be avoided.  You should also
  limit caffeine intake (colas, tea, coffee and chocolate, especially). These beverages
  may irritate your stomach.
• If you experience symptoms or side effects, especially if severe, be sure to discuss
  them with your health care team.  They can prescribe medications and/or offer
  other suggestions that are effective in managing such problems.

Monitoring and Testing

You will be checked regularly by your health care professional while you are taking
hydrocortisone, to monitor side effects and check your response to therapy. 
Periodic blood work to monitor your complete blood count (CBC) as well as the function
of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Cortisone Works:

Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids
influence the functioning of most of the body’s systems (heart, immune, muscles
and bones, endocrine and nervous system).  They exert a wide array of effects
including effects on the metabolism of carbohydrates, protein and fats.  They
help to maintain balance of fluids and electrolytes.

Hydrocortisone is classified as a corticosteroid (more precisely a glucocorticosteroid),
and has many uses in the treatment of cancer.

One way that it works is to decrease inflammation (swelling).  It does this
by preventing infection- fighting white blood cells (polymorphonuclear leukocytes)
from traveling to the area of swelling in your body. (This is why you are more prone
to infection while taking steroids).  Taking advantage of the anti-inflammatory
properties of the medication, corticosteroids are used to decrease the swelling
around tumors.   For example, by decreasing swelling around tumors in the spine,
brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve
pain or other symptoms caused by the pressing tumor.

Another way Cortisone works is by altering the body’s normal immune system responses. 
Corticosteroids are used to treat certain conditions that effect the immune system
such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic
Thrombocytopenia Purpura (TTP), or hemolytic anemia.

In addition, it is thought that corticosteroids may help in the treatment of patients
with blood disorders, such as multiple myeloma.  Corticosteroids may work by
causing programmed cell death (apoptosis) of certain cells, which may help to fight
your disease.

Corticosteroids are also used in the short-term treatment of nausea caused by chemotherapy.  
How it does this is not fully understood. They also have been used to stimulate
appetite for patients with severe appetite problems.

Corticosteroids are used to replace steroids in conditions of adrenal insufficiency
(low production of needed steroids produced by the adrenal glands).

Note:  We strongly encourage you
to talk with your health care professional about your specific medical condition
and treatments. The information contained in this website is meant to be helpful
and educational, but is not a substitute for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org

How to Reduce Corticosteroid Side Effects

How to think about the suggestions below: Any suggestion here which is not clear or which you think may not apply to you should be discussed with the your physician. Note also that the side effects of steroids very much depend on the dose and how long they are taken. If your dose is low, your risk of serious side effect is quite small, especially if precautions, as discussed below, are taken. Reading about these side effects may make you uncomfortable about taking steroids. You should be well aware of the risks before starting these medications. However, please be reassured that many people take steroids with minor or no side effects. Please also remember that steroids are often extremely effective and can be life-saving. If any of the suggestions here is unclear, or seems irrelevant to you, please discuss it with your physician.

Note on which “steroids” are we talking about: The term “steroids” here refers to anti-inflammatory steroids (corticosteroids) such as prednisone and methylprednisolone (Medrol®) and dexamethasone (Decadron®). The information below does not refer to muscle-building or “androgenic” steroids (such as testosterone), which share some chemical similarities but function quite differently than anti-inflammatory steroids.

Understanding corticosteroid side effects

With long-term use, corticosteroids can result in any of the following side effects. However, taking care of yourself as discussed below may reduce the risks.

Increased doses needed for physical stress

Steroid use for over two weeks can decrease the ability of your body to respond to physical stress. A higher dose of steroid may be needed at times of major stress, such as surgery or very extensive dental work or serious infection. This could be needed for as long as a year after you have stopped steroids.

Self-care tips:

• Discuss this possibility with the surgeon or dentist, etc. who is taking care of you at the time. Your physician or surgeon may not feel you need to take the extra steroid at the time of surgery, but if they know you have been on corticosteroids they can watch you more carefully after surgery.

Steroid withdrawal syndrome

When anti-inflammatory steroids have been taken for some time and then are rapidly withdrawn, our adrenal gland (which makes our body’s steroid hormones) can be sluggish in making our own steroid hormone. Taking anti-inflammatory steroids can lead to inhibition of the complex pathway that leads to our body’s production of anti-inflammatory steroid hormone (cortisol). Taking these anti-inflammatory steroids can suppress the hypothalamus, as well as the pituitary gland, which are all involved the process of stimulating the adrenal gland to make cortisol. For example, the pituitary gland production of ACTH (which stimulate the adrenal to make cortisol) can be inhibited. The adrenal gland itself can also show some suppression of its ability to make cortisol.  
Rapid withdrawal of steroids may cause a syndrome that could include fatigue, joint pain, muscle stiffness, muscle tenderness, or fever. These symptoms could be hard to separate from those of your underlying disease. Even with slower withdrawal of steroids, some of these symptoms are possible, but usually in milder forms. 

At times, rapid withdrawal of steroids can lead to a more severe syndrome of adrenal insufficiency. This can cause symptoms and health problems such as drops in blood pressure, as well as chemical changes in the blood such as high potassium or low sodium. Sometimes this can be set off by injuries or a surgical procedure. Because of this, make sure your doctors always know if you have been treated with steroids in the past, especially in the past year, so they can be on the alert for the development of adrenal insufficiency at times such as a surgical procedure.

Self-care tips:

• If you get symptoms like these when you taper your steroids, discuss them with the doctor. Your physician will work with you to continually try to taper your steroid dose, at a safe rate of decrease, depending on how you are doing. On each visit, discuss with the physician whether it is possible to decrease your steroid dose.
• Note that even if you are having a steroid side effect, however, steroids still must be tapered slowly.
• When used for less than two weeks, more rapid tapering of steroids is generally possible

Infection

Long-term steroids can suppress the protective role of your immune system and increase your risk of infection.

Self-care-tips:

• Since steroids can decrease your immunity to infection, you should have a yearly flu shot as long as you are on steroids. If you are on steroids for a prolonged period of time, you should also discuss with your doctor the possibility of getting “Pneumovax,” a vaccination against a certain type of pneumonia as well as “Prevnar 13,” another pneumonia vaccine. Shingles vaccination (Shingrix®) may also be considered. Your physician will take your age and risk factors into account when deciding which vaccinations you need.
• Signs of possible infection, such as high fever, productive cough, pain while passing urine, or large “boils” on the skin should have prompt medical attention. If you have a history of tuberculosis, exposure to tuberculosis, or a positive skin test for tuberculosis, report this to your doctor.

Gastrointestinal symptoms

Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. If at all possible, don’t combine steroids with NSAIDs. If you are on low-dose aspirin for heart protection, your physician may want you to continue this when you take the prednisone, but might consdier adding a medication for stomach protection during the course of steroids.

Self-care tips:

• Report to your physician any severe, persisting abdominal pain or black, tarry stools.
• Take the steroid mediation after a full meal or with antacids, as this may help reduce irritation of the stomach. Steroids can increase your appetite.

Osteoporosis

Steroid therapy can cause thinning of the bones (osteopenia and osteoporosis), and increase the risk of bone fractures. At the beginning or before your steroid therapy, many patients will be asked to have a bone density test, especially if the steroid dose is high. If density is low, the bone density study It will be repeated in the future to assess the effectiveness of measures you will be using to prevent bone loss. Preventative strategies are important: a person can lose 10% to 20% bone mass within the first six months of corticosteroid therapy.

Self-care tips:

• Most people taking corticosteroids will need to take a calcium supplement unless they can get enough calcium from their diet (if you can get it from your diet, that’s the best option). See this reference from the National Institutes of Health about how much calcium you need for your sex and age, and how to get as much as possible from diet.
• The minimal daily requirement of vitamin D is 800 international units (UI) daily, and most people on corticosteroids should take this amount. Your physician may check your vitamin D level and see if you actually need a higher dose.
• Smoking and alcohol increase the risk of osteoporosis, so limiting these is helpful.
• Weight-bearing exercise (walking, running, dancing, etc) is helpful in stabilizing bone mass.
• People on corticosteroids who have low bone density may be put on medications such as alendronate (Fosamax®) or Prolia®, and there are a number of others.
• Assess risk of falls. Make a thorough examination of your home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night lights.

Weight gain

Steroids affect your metabolism and how your body deposits fat. This can increase your appetite, leading to weight gain, and in particular lead to extra deposits of fat in your abdomen.

Self-care tips:

• Watch your calories and exercise regularly to try to prevent excessive weight gain. But don’t let weight gain damage your self-esteem. Know that the weight will be easier to take off in the six months to a year after you discontinue steroids.

Insomnia

Steroids may impair your ability to fall asleep, especially when they are taken in the evening.

Self-care tips:

• If possible, the physician will try to have you take your entire daily dose in the morning. This may help you sleep better at night (evening doses sometimes make it difficult to fall asleep).

Mood changes

Steroids, especially in doses over 30 milligrams per day, can affect your mood. Some people can feel depressed, some extremely “up” without any apparent reason. Just being aware that steroids can do this sometimes makes it less of a problem. Sometimes, this side effect requires that the steroid dosage be decreased. When the steroids are absolutely necessary, sometimes another medication can be added to help with the mood problem. Make sure your family knows about this possible side effect.

Self-care tips:

• Simply being aware that steroids can have an effect on your mood can sometimes make it less of a problem. But, at times, this side will require that the steroid dosage be decreased. If maintaining the same steroid dosage is absolutely necessary, sometimes another medication can be added to help with the mood problem.
• Make sure your family and friends know about this possible side effect so they will know what’s going on if you respond to them in unexpected ways. Ideally, tell your family and friends about this possible side effect as you start the medication, so that they can help you detect any changes in your behavior.

Fluid retention and elevated blood pressure

Because cortisone is involved in regulating the body’s balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure.

Self-care tips:

• Watch for swelling of your ankles, and report this to your doctor. Occasional patients benefit from diuretics (water pills). Low sodium diet helps reduce fluid accumulation and may help control blood pressure.
• Have your blood pressure monitored regularly while you are on steroids, especially if you have a history of high blood pressure. Steroids can raise blood pressure in some patients.

Elevated blood sugar

Since cortisone is involved in maintaining normal levels of glucose (sugar) in the blood, long-term use may lead to elevated blood sugar or even diabetes.

Self-care tips:

• Your blood sugar should be followed while you are on steroids, especially if you are a diabetic, since corticosteroids can raise blood sugar.

Eye problems

Steroids can sometimes cause cataracts or glaucoma (increased pressure in the eye).

Self-care tips:

• If you have a history of glaucoma or cataract follow up closely with the ophthalmologist while on steroids. If you develop any visual problems while on steroids, you will need to see the ophthalmologist. Temporarily blurred vision when you start corticosteroids is often not a serious problem, but ophthalmology evaluation should always be arranged if you experience other, new visual symptoms while taking steroids.

Atherosclerosis (hardening of the arteries)

It is possible that steroids may increase the rate of “hardening of the arteries,” which could increase the risk of heart disease. This risk is probably much more significant if steroids are taken for more than a year, and if taken in high dose.

Self-care tips:

• Low cholesterol diet may help. If you develop signs suggesting heart problem, such as chest pain, get medical attention quickly. Work with your physician to address any heart risks that can be modified, such as exercise, weight and cholesterol level.

Aseptic necrosis

• Steroids, particularly at higher doses for long periods of time, can sometimes lead to damage to bones, called aseptic necrosis (also known as osteonecrosis or avascular necrosis). This can happen in a number of joints, but the hip is the most common.

Self-care tips:

• Hip pain, especially if you have no known hip arthritis, could be an early sign of this damage. Report this to your doctor.

Updated: 8/5/2021

Authors

Steroid injections – NHS

Steroid injections, also called corticosteroid injections, are anti-inflammatory medicines used to treat a range of conditions.

They can be used to treat problems such as joint pain, arthritis, sciatica and inflammatory bowel disease.

Steroid injections are only given by healthcare professionals. Common examples include hydrocortisone, triamcinolone and methylprednisolone.

How steroid injections are given

Steroid injections are usually given by a specialist doctor in hospital.

They can be given in several different ways, including:

• into a joint (an intra-articular injection)
• into a muscle (an intramuscular injection)
• into the spine (an epidural injection)
• into the blood (an intravenous injection)

The injections normally take a few days to start working, although some work in a few hours. The effect usually wears off after a few months.

If you’re having an injection to relieve pain, it may also contain local anaesthetic. This provides immediate pain relief that lasts a few hours.

You should be able to go home soon after the injection. You may need to rest the treated body part for a few days.

Side effects of steroid injections

Possible side effects of steroid injections depend on where the injection is given.

Side effects of injections into the joints, muscles or spine can include:

• pain and discomfort for a few days – paracetamol may help with this
• temporary bruising or a collection of blood under the skin
• flushing of the face for a few hours
• an infection, causing redness, swelling and pain – get medical advice as soon as possible if you have these symptoms
• a loss of fat where the injection was given – this can cause dimples in the skin and may be permanent
• paler skin around the site of the injection – this may be permanent
• if you have diabetes, your blood sugar level may go up for a few days
• if you have high blood pressure, your blood pressure may go up for a few days

Epidural injections can also occasionally give you a very painful headache that’s only relieved by lying down. This should get better on its own, but tell your specialist if you get it.

Side effects of injections given into the blood tend to be similar to side effects of steroid tablets, such as increased appetite, mood changes and difficulty sleeping.

You can report any suspected side effect to a UK safety scheme.

Who can have steroid injections

Most people can have steroid injections.

Tell the doctor before having treatment if you:

• have had a steroid injection in the last few weeks – you usually need to wait at least 6 weeks between injections
• you’ve had 3 steroid injections in the last year – doctors usually recommend no more than 3 injections in the same area in the space of 12 months
• have had an allergic reaction to steroids in the past
• have an infection (including eye infections)
• have recently had, or are about to have, any vaccinations
• are pregnant, breastfeeding or trying for a baby
• have any other conditions, such as diabetes, epilepsy, high blood pressure, or problems with your liver, heart or kidneys
• are taking other medicines, such as anticoagulants

Steroid injections may not always be suitable in these cases, although the doctor may recommend them if they think the benefits outweigh any risks.

How steroid injections work

Steroids are a manmade version of hormones normally produced by the adrenal glands, 2 small glands found above the kidneys.

When injected into a joint or muscle, steroids reduce redness and swelling (inflammation) in the nearby area. This can help relieve pain and stiffness.

When injected into the blood, they can reduce inflammation throughout the body, as well as reduce the activity of the immune system, the body’s natural defence against illness and infection.

This can help treat autoimmune conditions, such as multiple sclerosis (MS), which are caused by the immune system mistakenly attacking the body.

Steroid injections are different from the anabolic steroids used illegally by some people to increase their muscle mass.

Page last reviewed: 26 February 2020
Next review due: 26 February 2023

What are the Side Effects of Cortisone Injections?

This short assessment of the benefits and risks of cortisone injections comes from the journal Pain Physician (1) January 2021:

“The current evidence would suggest that the use of corticosteroids provides moderate evidence for short-term pain reduction and improvement in function. There are multiple potential adverse effects, such as toxic damage to articular cartilage, as well as numerous systemic side effects, including a reduction in immune function and an increased risk of infection, of which physicians need to be aware.”

For more than 33 years, the Magaziner Center for Wellness has been at the forefront in using new and innovative treatments for healing acute and chronic back and joint pain. Over this time we have seen many chronic pain patients who have had significant relief from cortisone injections, sometimes short-term, sometimes long-term, but the effects have now “worn off,” and these patients are seeking options.

We have also seen patients who have not had significant relief and in fact suffered from terrible side-effects directly related to the cortisone steroid injection. These people are also looking for the alternative, new, and innovative treatment options. Later in this article we will discuss these options. First, let’s look at new research at some of the problems patients face after steroid injections for back pain and joint pain.

After the epidural 

A November 2019 (2) study examined the adverse effects of an Epidural Steroid Injection which are attributable to the systemic effects of corticosteroids. In the introduction to the study the researchers listed the potential complications:

“Central steroid response (this is a nervous system adverse response), including sleeplessness, flushing, and non-positional headache, insomnia, hiccups, flushing, and increased radicular pain, represents some of the most common immediate or delayed adverse event related to epidural steroid injections.”

The systemic effects of corticosteroids (this is the whole boyd adverse response) themselves likely represent the most commonly encountered complications that result from Epidural Steroid Injection. These include hyperglycemia, hypothalamic-pituitary-adrenal axis suppression, decreased bone mineral density, and others. ”

What does the hypothalamic-pituitary-adrenal axis do? What happens when it is suppressed?

Suppression of the hypothalamic-pituitary-adrenal axis can result in an impaired digestive system, an impaired immune system,sexual dysfunction, mood and emotional swings, dysfunction of the body’s energy systems that will lead to excessive fatigue.

After the joint injections

A December 2018 study (3) examined the negative impact of and side effects of steroid injections into the spine and joints. Here is what they found:

“Local glucocorticoid injections are often used to treat joint, soft tissue, or spinal pain, but the systemic side effects associated with these injections are poorly understood and not well recognized. There are significant known risks to systemic administration of glucocorticoids. However, there are no guidelines that address issues of systemic absorption, overall systemic risks, or other side effects of locally injected glucocorticoids. . . it is clear that both intra‐articular and epidural injections can have systemic effects for weeks and that complications may be associated with their use, including Cushing syndrome (too much too much cortisol in the blood causing fatty hump between the shoulders, a “moon-face” rounded appearance among other challenges), loss of bone density, infection, and hyperglycemia.

The concurrent use of oral steroids, the number of injections, and the type and dose of glucocorticoids used all are important considerations in estimating risks.”

The researchers here point out that if a patient is taking oral steroids it supplies a cumulative dose that needs to be considered in the possibility of increasing side-effect risks.

At the Magaziner Center for Wellness, we have successfully, non-surgically, treated treat back and spinal issues and without resorting to cortisone or long-term medication usage. Using prolotherapy, Prolozone®, platelet-rich plasma and cellular regenerative therapies, we accelerate and enhance the body’s natural healing process. By combining these therapies with good nutrition, healthy nutraceuticals, energy medicine and osteopathic manipulation, we have been able to successfully reduce pain in thousands of patients.

Cortisone and hyaluronic acid

Here is what a May 2018 study (4) noted:

“The efficacy of corticosteroid and hyaluronic acid injections for knee osteoarthritis has been questioned. The purpose of this study was to determine the impact of the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines on the use of these injections in the United States and determine if utilization differed by provider specialty.”

A little background:

(After new AAOS guidelines were issued that questioned how effective these treatments were: “The trend in use of hyaluronic acid injections by orthopedic surgeons and pain specialists decreased with time following the second-edition clinical practice guideline but did not change for primary care physicians or nonoperative musculoskeletal providers.

Subtle but significant changes in hyaluronic acid and corticosteroid injections occurred following the publication of (new) clinical practice guidelines. Although the clinical practice guidelines did impact injection use, given the high costs of these injections and their questionable clinical efficacy, further interventions beyond publishing clinical practice guidelines are needed to encourage higher-value care for patients with knee osteoarthritis.”

Corticosteroid injections in the hip and knee: Not as safe as doctors think

In October 2019, doctors published their study: “Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?” in the medical journal Radiology.(5). Here is what they wrote:

“Intra-articular corticosteroid injections are frequently performed to treat osteoarthritis and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. ”

Do cortisone injections accelerate osteoarthritis damage?

“There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated osteoarthritis progression or adverse joint events, after treatment with Intra-articular corticosteroid injection.

Four main adverse joint findings have been structurally observed in patients after Intra-articular corticosteroid injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss.”

Corticosteroids mess up your stem cells

Among the regenerative medicine treatments that we offer patients with chronic joint and back pain is stem cell therapy. Stem cell therapy seeks to repair damage in the joints by rebuilding tissue at the cellular level. One of the aspects of the treatment is the mobilization of the native stem cells in the joint to work with the injected materials to begin a new healing cycle. This is explained further in the related articles we highlighted below and we invite you to read these articles for a better understanding of our non-surgical treatment options.

But what if the native stem cells have been damaged by cortisone abuse?

A recent study from the Mayo Clinic (6) examined the “deleterious effects of corticosteroids on chondrocytes, suggesting a potentiation of degenerative joint disease.” Let’s explain this.

In the research above, corticosteroids were blamed for accelerating osteoarthritis damage in the hips and joints. How does it do this? One way is by altering the function of the chondrocyte. This is a cell that secretes the cartilage building blocks and then embeds itself within this secretion to make itself part of new cartilage.

The Mayo Clinic research suggests that Mesenchymal stem cells (the type of stem cell used in joint repair) are the direct progenitors of chondrocytes (where new cartilage begins to form) and other musculoskeletal tissue. Additionally, they serve an important anti-inflammatory role, which can combat the chronic inflammatory state that mediates degenerative joint disease. Corticosteroids frequently are used by physicians to reduce inflammation in patients with musculoskeletal disorders, may hinder Mesenchymal stem cells’ innate regenerative capacity in exchange for temporary analgesia.”

Options

It is clear from these studies that cortisone does not heal joint and back pain, it suppresses inflammation. If you had cortisone injections and are still seeking pain relief, you know this to be true in your case. If you would like to explore more information on treating your back or joint pain, please contact our office so we can start a conversation with you.

Related articles:

Cortisone Injections Cause Post-Surgical Rotator Cuff Complication

Platelet Rich Plasma Therapy Injections for Knee Osteoarthritis Patients

Stem Cell Therapy for Bone on Bone Knees

Hyaluronic Acid Viscosupplementation or Platelet Rich Plasma For Knee Pain Patients

References

1 Stone S, Malanga GA, Capella T. Corticosteroids: Review of the History, the Effectiveness, and Adverse Effects in the Treatment of Joint Pain. Pain Physician. 2021 Jan;24(S1):S233-S246. PMID: 33492920.
2 Rosati R, Schneider BJ. Systemic Effects of Steroids Following Epidural Steroid Injections. Current Physical Medicine and Rehabilitation Reports. 2019 Dec 1;7(4):397-403.
3 Stout A, Friedly J, Standaert CJ. Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. PM&R. 2019 Apr;11(4):409-19.
4 Bedard NA, DeMik DE, Glass NA, Burnett RA, Bozic KJ, Callaghan JJ. Impact of clinical practice guidelines on use of intra-articular hyaluronic acid and corticosteroid injections for knee osteoarthritis. JBJS. 2018 May 16;100(10):827-34.
5 Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: Perhaps not as safe as we thought?. Radiology. 2019 Oct 15;293(3):656-63.
6 Wyles CC, Houdek MT, Wyles SP, Wagner ER, Behfar A, Sierra RJ. Differential cytotoxicity of corticosteroids on human mesenchymal stem cells. Clinical Orthopaedics and Related Research®. 2015 Mar 1;473(3):1155-64.

90,000 Attention, cortisone! Is it really that bad?

When patients are prescribed cortisone, they often panic. These drugs are notorious for their high active ingredient content and unpleasant side effects. It is believed that cortisone is getting better. Is it true?

Cortisone is one of the most potent substances that scientists have ever discovered. This is an artificial hormone, which is more correctly called a glucocorticoid. Many patients who have been prescribed the hormone are afraid to take it, thinking that they will definitely get better.These fears are not always well founded.

Is the cortisone in skin creams dangerous?

Medicines containing cortisone for topical use include nasal sprays, skin creams, asthma aerosols. Patients who are prescribed such drugs, for example, in the treatment of allergic rhinitis or neurodermatitis, do not need to worry. The fears remain from the days when glucocorticoids were used at a high dosage and, accordingly, caused severe side effects.When applied locally, the substance enters the bloodstream in very small doses or does not enter at all.

If the creams are applied over large areas of the skin or for an extended period, the skin may become thinner over time. The advantage of glucocorticoids is that they act very quickly, the patient can stop taking the drug at any time.

In the case of a cortisone spray for asthma, the patient needs to brush his teeth and drink some liquid after each procedure. The fact is that drops of medicine remaining in the mouth reduce the immune defense.This can lead to fungal infections.

When is cortisone tablets prescribed?

Many patients take cortisone tablets. In this case, the active substance enters the bloodstream. In autoimmune diseases, such as rheumatoid arthritis (RA), the immune system works against its own body. Therefore, in some cases, it is weakened with glucocorticoids. Patients are also treated with other drugs that affect the immune system and reduce inflammation.

How does cortisone work?

Glucocorticoids, unlike other anti-inflammatory drugs, are able to penetrate directly into cells. They attach themselves from the inside to one of the receptors – a kind of guardian of the cell, and then along with it they enter the cell nucleus, where they influence the reading of genetic information.

They literally prevent the emergence of inflammatory mediators, that is, biologically active substances that cause and support the inflammatory process.At the same time, glucocorticoids help the body prevent its occurrence on its own. But, unfortunately, hormones affect not only the inflammatory process, but, in particular, the metabolism. That is why they sometimes cause side effects.

Side effects of cortisone

Patients who use cortisone for a long time may experience the following side effects:

• osteoporosis;
• diabetes mellitus;
• cataract;
• weakening of the immune system;
• diseases of the cardiovascular system.

Are you recovering from cortisone?

Most of all, patients are afraid of side effects that are not actually dangerous to health. People get better primarily in the middle part of the body, their face is also rounded and their neck becomes wider.

What dose can become poison

Doctors prescribe the dose of the drug that is necessary for effective treatment – as little cortisone as possible. 5 mg per day of the most common drug called Prednisolone does more benefit than harm for most patients.If you take the medicine at 10 mg per day for six months, it can do more harm than good.

The task of the doctor is to reduce the dosage over time, and then completely cancel the drug. However, this is not always possible.

How to avoid side effects

Patients themselves can take measures to avoid unwanted side effects. Osteoporosis can be prevented by eating calcium-rich foods and exercising actively.Calcium is found in dairy products and fish.

Vitamin D, found in fatty marine fish and avocado, is also very important for bones. Since vitamin D is produced by ultraviolet rays, doctors advise taking at least half an hour outside for a walk every day.

It is important to quit smoking: nicotine not only increases the risk of rheumatism, but also aggravates the disease.

Glucocorticoids are one of the most effective anti-inflammatory drugs known in medicine.They were discovered in 1935 by American scientists in the human adrenal cortex. 15 years later, researchers were awarded the Nobel Prize for this discovery. Doctors use artificially created glucocorticoids to combat inflammation and atypical immune responses.

Cortisone – is it good for you? – LLC “Altermedica”

Some patients have doubts about the use of cortisone for treatment and its effects on the body. The most common doubts include:

• Cortisone is not a natural joint substance.
• Cortisone causes joint and cartilage damage
• Cortisone may cause tendon rupture.
• Cortisone injections are painful .

Cortisone can be used in a variety of conditions. Its mechanism of action is based on suppressing inflammation. Anti-inflammatory drugs can be taken orally, but with this method of administration, the drug is distributed in small doses throughout the body.

Unlike oral administration, cortisone injection allows a large, powerful dose to be administered locally to the site of inflammation. Therefore, the drug acts precisely and effectively at the site of the problem. Moreover, with this route of administration, systemic side effects are very unlikely.

Cortisone injections are one of the most effective treatments in orthopedics. Cortisone is a potent anti-inflammatory drug that reduces the inflammatory response in many disease states.Cortisone is effective for various types of arthritis, tendinitis, bursitis, and other conditions.

Due to the pronounced and rapid effects of cortisone injection, this treatment is often recommended for various orthopedic conditions. Among the most common pathologies for which cortisone injections are used:

• Shoulder bursitis / rotator cuff inflammation
• Knee arthritis
• Tennis elbow syndrome
• Snap finger syndrome

Cortisone injections are also often used in the treatment of pathologies of the cervical and lumbar spine.In these cases, the drug can be administered epidurally.

Pros

Cortisone injections can be an excellent treatment for many diseases of an inflammatory nature. Sometimes, even a small dose of cortisone can effectively reduce the inflammatory response and resolve the problem.

Cortisone is easy to administer and dose with minimal side effects. Cortisone is a naturally occurring substance produced by the human body, and although the dose administered is much higher than the natural amount, cortisone is well tolerated by most patients.

Positive characteristics of cortisone:

• Cortisone natural substance
• Cortisone injections can be performed with minimal patient discomfort
• Side effects occur infrequently

Cons

As already mentioned, the injection creates a local high content of cortisone. Laboratory studies have shown that high concentrations of cortisone or its intermittent use can damage body tissues, soften cartilage or weaken the ligaments.

The main limitation of the use of cortisone is its use in a young patient with healthy joints. In older patients with worn joints and damaged tendons, the use of cortisone is more reasonable because there are already structural changes. Therefore, young athletes are advised to first use all possible treatment options before resorting to cortisone injections.

In addition, certain tendons are prone to rupture when treated with cortisone injections.The most common example is the Achilles tendon. Even with careful administration of the drug, injections of cortisone can lead to traumatic rupture of this tendon.

CV

Cortisone injections are an excellent treatment for many conditions. In many patients with joint damage (for example, those with advanced knee arthritis), it is unlikely that cortisone will cause additional harm. In these patients, intermittent cortisone injections may delay the need for joint replacement surgery.

We believe that the use of cortisone injections in young people with healthy joints should be treated with caution. In such patients, all other potentially effective treatment options, such as oral anti-inflammatory drugs, heat and cold therapy, and physical therapy, must first be tried. If these methods are ineffective, cortisone can be used, but rarely and in limited doses.

In certain cases, extra care must be taken.These cases: injections of cortisone for inflammation of the Achilles tendon, plantar fasciitis and a number of other pathologies.

Original article

Features of synthesis, activation and deactivation of glucocorticoids. The biological role of cortisol in metabolic disorders | Artemova

Introduction

Any scientific discovery is based on the accumulation of a large number of clinical observations, literature data, followed by the summation and systematization of knowledge and the advancement of a new hypothesis.Currently, there is a sufficient amount of information about the mechanisms of action of cortisol and its cellular targets, local and systemic action, however, ongoing experimental studies open up more and more new data on the biological role of the hormone. Cholesterol, either obtained from food or synthesized endogenously from acetate, serves as the initial substrate in steroidogenesis. Three main biosynthetic pathways in the adrenal cortex lead to the formation of glucocorticoids, mineralocorticoids, and adrenal androgens.The outer (glomerular) zone is involved mainly in the biosynthesis of aldosterone, while the inner (bundle and reticular) zones serve as a site for the biosynthesis of glucocorticoids and androgens. The main glucocorticoid hormone in humans is hydrocortisone (cortisol). The daily secretion of cortisol is 15–30 mg and has a pronounced circadian rhythm. Plasma cortisol is present in three forms: free, bound to protein, and as metabolites. Normally, free, biologically active cortisol accounts for about 5% of its amount present in the blood.Approximately 90% of cortisol is bound by a specific protein (a2-globulin) – transcortin, which has a high hormone-releasing agent. Less than 5% of cortisol is bound by a low-affinity protein called albumin. It should be noted that its biological activity, which manifests itself in a direct effect on tissues, depends on the amount of free cortisol. Normally, glucocorticosteroids (GCS) are involved in all types of metabolism (in the metabolism of proteins, carbohydrates, lipids), and therefore the pathophysiological and clinical changes in hypercortisolism vary widely.Hyperproduction of glucocorticoids can be a consequence of an increase in the level of adrenocorticotropic hormone in pituitary tumors (Itsenko-Cushing’s disease), tumors originating from other cells (bronchi, thymus, pancreas) that produce corticotropin-like substances, or excessive synthesis of cortisol by the cortex of the adrenal glands (Kushin syndrome) … On the example of these orphan diseases, various effects of excess cortisol on organs and tissues have been studied. With hypercortisolism, there is a violation of glucose tolerance or diabetes mellitus, caused by the stimulation of gluconeogenesis and the development of insulin resistance, increased protein catabolism, a decrease in muscle mass, thinning of the skin, osteoporosis, involution of lymphoid tissue, a kind of redistribution and changes in the morphological composition of adipose tissue.As you know, glucocorticoids model the physiology of adipose tissue, changing the secretion of adipokines directly or in connection with developing insulin resistance, stimulate the differentiation of adipocytes, promoting the formation of new adipose tissue cells by activating the transcription of a number of key genes [1, 2]. Hypernatremia, hypokalemia and, as a consequence, arterial hypertension are due to some mineralocorticoid activity of cortisol, which is manifested in its excess.

As research data show, in obesity and type 2 diabetes mellitus (DM), functional hypercortisolism is often found, which is not caused by the overproduction of the hormone by the tumor tissue.According to the World Health Organization, in 2007 there were 523 million obese patients worldwide. WHO predicts that by 2025 half of the world’s population will be overweight [3]. According to the International Diabetes Federation (IDF), the prevalence of diabetes among the adult population of the planet (20–79 years) is about 9% or, in absolute terms, 415 million people. According to experts, by 2040 their number will reach 642 million. The steady growth in the number of patients with diabetes (mainly type 2) and obesity poses new challenges for the development of effective drugs and forms of their delivery, methods of early detection and prevention of the development of the disease.

Cortisol and metabolic syndrome

It is well known that corticosteroids affect the distribution of adipose tissue. Several studies have shown that obese patients have hyperactivation of the 11β-HSD1 enzyme in adipose tissue [4, 5] and hepatocytes, a key enzyme that stimulates the conversion of metabolically inactive cortisone to active cortisol (Fig. 1). In contrast, 11β-hydroxysteroid dehydrogenase 2 (11β-HSD2), which catalyzes the conversion of cortisone to cortisol, had a low expression.

Fig. 1 Conversion of cortisol to cortisone

As mentioned earlier, it has been suggested that 11β-HSD1 activity may be one of the pathogenetic mechanisms underlying the development of metabolic syndrome. Data from experimental studies on animals showed that selective 11β-HSD1 overexpression in adipose tissue (similar to that observed in obese patients) led to the development of metabolic syndrome, and, in particular, dyslipidemia, obesity, hypertension associated with activation of the renin- angiotensin-aldosterone, insulin resistance and impaired carbohydrate metabolism.In addition, adipocytes were larger (Fig. 2) than usual, the main effect was observed in visceral adipose tissue, possibly due to a higher density of receptors for GCS [6, 7, 8].

Fig. 2 Electron micrograph of adipocytes

The data obtained made it possible to consider 11b-HSD1 as a new target for pharmacotherapy. A phase II randomized, double-blind, placebo-controlled study of the efficacy of the selective inhibitor 11b-HSD1 (INCB013739) in overweight / obese patients with type 2 diabetes showed statistically significant increases in hepatic and peripheral insulin sensitivity, decreases in fasting plasma glucose, total cholesterol and low density lipoproteins (LDL), plasma triglycerides and blood pressure [9].The question remains open: how does the local hyperproduction of GCS affect the systemic level of cortisol and is the negative feedback mechanism disturbed?

Cortisol and cardiovascular risks

According to Colao A. et al., Within five years after the onset of remission of Itsenko-Cushing’s disease, the concentrations of cholesterol, LDL, atherogenic index, insulin levels remain above the reference values, which puts these patients in a high risk group for cardiovascular complications even after achieving remission of the disease [10–12].

In addition to the listed metabolic factors underlying cardiovascular disorders, cortisol has an inhibitory effect on angiogenesis. Angiogenesis should be understood as the process of growth of new blood vessels, which is necessary in tissue repair and in other diseases that occur with the development of tissue ischemia, such as ischemic heart disease, chronic arterial insufficiency of the lower extremities, etc.

Regulation of angiogenesis by hypoxia is an important component of homeostasis.Normally, in response to a decrease in tissue oxygen content, hypoxia inducible factor Ia (HIF-1) stimulates the growth of new vessels. The same mechanism works in ischemic tissues [13].

HIF-1 controlled production of vascular endothelial growth factor (VEGF) leads to autocrine signaling, which is critical for angiogenesis. Many of the biological processes in angiogenesis, invasion of the extracellular matrix and tube formation by endothelial cells are stimulated under hypoxic conditions through HIF-1, which activates the transcription of dozens of genes whose protein products play a decisive role in these processes [14].

As research data show, in the process of pathological restructuring of the myocardium, its hypertrophy, and then dilation with the development of heart failure, one of the key roles is played by HIF-1. HIF-1 stimulates the production of VEGF, which in turn binds to a receptor on the surface of endothelial cells. This is followed by activation of the ERK signaling pathway (Ras-ERK and MAPK / ERK), which stimulates the proliferation and migration of endothelial cells [15, 16, 17].

Glucocorticoid-mediated inhibition of angiogenesis plays an important role in physiology, pathophysiology, and therapeutic approaches to several diseases.However, the mechanisms by which glucocorticoids inhibit the growth of new blood vessels are not fully understood. In a pilot study by James J. Logie et al. demonstrated that even physiological levels of glucocorticoids suppress angiogenesis by directly preventing endothelial cells from forming vascular tubes. In the process of angiogenesis, endothelial cells begin to actively proliferate, the process of transformation of their morphological structure starts, which leads to the formation of highly ordered cell lines that make up the inner layer of newly formed vessels.

Exposure to cortisol reduces cell-cell contact formation without impairing endothelial cell proliferation, migration, or viability. Previous studies show that glucocorticoids suppress angiogenesis by inhibiting VEGF synthesis [18, 19, 20], which proves the inhibitory effect of cortisol on signaling pathways that initiate tubule formation.

Thus, in conditions of hypersecretion of cortisol, VEGF-mediated angiogenesis is impaired, which more quickly leads to maladjustment of the processes of compensation of cardiac activity and the development of severe heart failure, which causes an unfavorable prognosis in patients with hypercortisolism of any etiology.

Synthesis of cortisol in the skin. Regulation of repair

Obesity and obesity-associated conditions are accompanied by impaired physiological repair, which increases the likelihood of delayed wound healing. Obese people have a high risk of developing venous ulcers, various skin diseases (eg, candidiasis, erythrasma) or more serious skin infections (eg, cellulitis, necrotizing fasciitis), and purulent complications after surgery. However, the role of GCS in the regulation of wound repair is currently poorly understood.

Along with the adrenal tissue synthesizing glucocorticoids, more and more data began to appear on the sites of extraadrenal cortisol production, such as the brain, lungs, heart, thymus, cells of the immune system, and skin [21, 22].

Despite the main function of the skin to serve as a barrier to protect the internal environment of the body from aggressive influences, recent studies in dermatology have been devoted to the study of the ability of epidermal cells to secrete hormones. The ability to interact with the central nervous system through local production of hormones, neuropeptides, neuropeptides, neurotransmitters, and other regulatory factors into the systemic circulation allows the skin to be considered as a neuroendocrine organ [23].

Keratinocytes are the first cells that react to damage to the integrity of the skin, which triggers a cascade of reactions, which contributes to a change in the phenotype of keratinocytes, leads to their migration and proliferation, a change in the ability of keratinocytes to adhere and configure the cytoskeleton [24] (Fig. 3).

Fig. 3 Immunofluorescence micrograph of keratinocytes

Keratinocytes have the ability to synthesize cholesterol, which is the precursor of all steroid hormones.In addition, as shown by a number of studies, skin cells are able to secrete hypothalamic-pituitary hormones: proopiomelanocortin, adrenocorticotropic hormone, thyroid-stimulating hormone and growth hormone [25, 26, 27, 28].

Expression of key steroidogenesis enzymes in the skin supports the hypothesis that the epidermis may be the main site of extra-adrenal cortisol synthesis. As expected, enzymes that control cortisol activity, namely the conversion to inactive cortisone 11b-HSD1 and 11b-HSD2, are also expressed by a variety of keratinocyte subtypes.Expression of CYP11B1 is predominantly expressed in the basal and suprabasal layers of the epidermis. These layers of the epidermis have the greatest ability to proliferate and are the main sources for tissue regeneration [29].

Expression of CYP11B1, a key enzyme in the synthesis of cortisol, increases in response to ACTH or proinflammatory cytokines IL-1, which indicates a direct stimulatory effect of proinflammatory cytokines [30] and decreases in response to metirapone. Apparently, the secretion of cortisol in response to tissue damage first increases and reaches a peak 48 hours after exposure to the damaging agent, and then, when the wound enters the proliferation stage, gradually decreases to the initial level after 96 hours, which is confirmed by data from studies on human culture. keratinocytes.After 96 hours, the expression of 11-HSD2, an enzyme that converts the conversion of active cortisol to inactive cortisone, increases. To confirm the hypothesis of the existence of a negative feedback cortisol / IL-1, an inhibitor of cortisol synthesis, metyrapone, was added to the cell culture. Compared to controls, the metirapone group showed an increase in IL-1 expression, which confirms the presence of a feedback loop that regulates the initial response to tissue damage, preventing excessive inflammation that can lead to further tissue damage.

According to recent studies, glucorticoids act through the Wnt signaling pathway, thereby affecting the cell cycle of keratinocytes, inhibiting proliferation, migration, and inducing cell differentiation. In addition, GCS inhibit the effect of epidermal growth factor (EGF), which directly stimulates cell migration and proliferation [31, 32].

Thus, even with functional hypercortisolism, due to the described mechanisms, normal tissue repair is impaired.The epidermis of wounds loses the ability to proliferate and migrate, which can lead to long-term persistence of wound defects.

Conclusion

In light of the emerging new data, the view of the hypothalamus-pituitary-adrenal-target organs system undergoes significant changes, and along with the negative feedback mechanism, assumptions arise about the existence of other regulatory mechanisms for the synthesis, activation and deactivation of GCS. However, there is currently a relatively small amount of data on the relationship between systemic and local production of cortisol in tissues.Understanding these processes will create the necessary scientific basis for the search and development of new targets for pharmacotherapy of diseases associated with impaired synthesis, activation and action of GCS.

Additional information

Conflicts of interest

The authors declare no conflict of interest.

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2. Rask E, Walker BR, Söderberg S, et al. Tissue-specific changes in peripheral cortisol metabolism in obese women: Increased adipose 11β-hydroxysteroid dehydrogenase type 1 activity. J Clin Endocrinol Metab. 2002; 87 (7): 3330-3336. doi: 10.1210 / jc.87.7.3330.

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4. Pereira CD, Azevedo I, Monteiro R, Martins MJ. 11β-Hydroxysteroid dehydrogenase type 1: relevance of its modulation in the pathophysiology of obesity, the metabolic syndrome and type 2 diabetes mellitus.Diabetes Obes Metab. 2012; 14: 869-881. doi: 10.1111 / j.1463-1326.2012.01582.x.

5. Morgan S a, McCabe EL, Gathercole LL, et al. 11β-HSD1 is the major regulator of the tissue-specific effects of circulating glucocorticoid excess. Proc Natl Acad Sci U S A. 2014; 111 (24): E2482-91. doi: 10.1073 / pnas.1323681111.

6. Bujalska IJ, Walker EA, Tomlinson JW, Hewison M, Stewart PM.11Beta-hydroxysteroid dehydrogenase type 1 in differentiating omental human preadipocytes: from de-activation to generation of cortisol. Endocr Res. 2002; 28 (4): 449-461. doi: 10.1081 / ERC-120016822.

7. Masuzaki H, Paterson J, Shinyama H, et al. A Transgenic Model of Visceral Obesity and the Metabolic Syndrome. Science (80-). 2001; 294 (5549): 2166-2170. doi: 10.1126 / science.1066285.

8.Wamil M, Seckl JR. Inhibition of 11beta-hydroxysteroid dehydrogenase type 1 as a promising therapeutic target. Drug Discov Today. 2007; 12 (13-14): 504-520. doi: 10.1016 / j.drudis.2007.06.001.

9. Joharapurkar A, Dhanesha N, Shah G, Kharul R, Jain M. 11β-Hydroxysteroid dehydrogenase type 1: potential therapeutic target for metabolic syndrome. Pharmacol Rep. 2012; 64 (5): 1055-1065.

10.Colao A, Pivonello R, Spiezia S, et al. Persistence of increased cardiovascular risk in patients with Cushing’s disease after five years of successful cure. JClinEndocrinolMetab. 1999; 84 (0021-972X (Print)): 2664-2672.

11. Sharma ST, Nieman LK, Feelders RA. Comorbidities in Cushing’s disease. Pituitary. 2015; 18 (2): 188-194. doi: 10.1007 / s11102-015-0645-6.

12.Espinosa-de-Los-Monteros AL, Sosa E, Martinez N, Mercado M. Persistence of Cushing’s disease symptoms and comorbidities after surgical cure: a long-term, integral evaluation. Endocr Pract. 2013; 19 (2): 252-258. doi: 10.4158 / EP12247.OR [doi].

13. Hirota K, Semenza GL. Regulation of angiogenesis by hypoxia-inducible factor 1. Crit Rev Oncol Hematol. 2006; 59 (1): 15-26. doi: 10.1016 / j.critrevonc.2005.12.003.

14.Webb JD, Coleman ML, Pugh CW. Hypoxia, hypoxia-inducible factors (HIF), HIF hydroxylases and oxygen sensing. Cell Mol Life Sci. 2009; 66 (22): 3539-3554. doi: 10.1007 / s00018-009-0147-7.

15. Hoeben A, Landuyt B, Highley MS, Wildiers H, Van Oosterom AT, De Bruijn E a. Vascular endothelial growth factor and angiogenesis. Pharmacol Rev. 2004; 56 (4): 549-580. doi: 10.1124 / pr.56.4.3.549.

16.Holmes K, Roberts OL, Thomas AM, Cross MJ. Vascular endothelial growth factor receptor-2: structure, function, intracellular signaling and therapeutic inhibition. Cell Signal. 2007; 19 (2007): 2003-2012. doi: 10.1016 / j.cellsig.2007.05.013.

17. Oka T, Morita H, Komuro I. Novel molecular mechanisms and regeneration therapy for heart failure. J Mol Cell Cardiol. 2016; 92: 46-51. doi: 10.1016 / j.yjmcc.2016.01.028.

18. Matsuda S, Gomi F, Oshima Y, Tohyama M, Tano Y. Vascular endothelial growth factor reduced and connective tissue growth factor induced by triamcinolone in ARPE19 cells under oxidative stress. Invest Ophthalmol Vis Sci. 2005; 46 (3): 1062-1068.

19. Rao R, Redha R, Macias-Perez I, et al. Prostaglandin E2-EP4 receptor promotes endothelial cell migration via ERK activation and angiogenesis in vivo.J Biol Chem. 2007; 282 (23): 16959-16968. doi: 10.1074 / jbc.M701214200.

20. Logie JJ, Ali S, Marshall KM, Heck MMS, Walker BR, Hadoke PWF. Glucocorticoid-mediated inhibition of angiogenic changes in human endothelial cells is not caused by reductions in cell proliferation or migration. PLoS One. 2010; 5 (12). doi: 10.1371 / journal.pone.0014476.

21.Slominski A, Zbytek B, Nikolakis G, et al. Steroidogenesis in the skin: implications for local immune functions. J Steroid Biochem Mol Biol. 2013; 137: 107-123. doi: 10.1016 / j.jsbmb.2013.02.006.

22. Cirillo N, Prime SS. Keratinocytes synthesize and activate cortisol. J Cell Biochem. 2011; 112 (6): 1499-1505. doi: 10.1002 / jcb.23081.

23.Slominski A, Wortsman J, Kohn L, et al. Expression of hypothalamic-pituitary-thyroid axis related genes in the human skin. J Invest Dermatol. 2002; 119 (6): 1449-1455. doi: 10.1046 / j.1523-1747.2002.19617.x.

24. Jamora C, DasGupta R, Kocieniewski P, Fuchs E. Links between signal transduction, transcription and adhesion in epithelial bud development. Nature. 2003; 422 (6929): 317-322. doi: 10.1038 / nature01893.

25. Slominski A, Malarkey WB, Wortsman J, Asa SL, Carlson A. Human skin expresses growth hormone but not the prolactin gene. J Lab Clin Med. 2000; 136 (6): 476-481. doi: 10.1067 / mlc.2000.110605.

26. Kono M, Nagata H, Umemura S, Kawana S, Osamura RY. In situ expression of corticotropin-releasing hormone (CRH) and proopiomelanocortin (POMC) genes in human skin.FASEB J. 2001; 15 (12): 2297-2299. doi: 10.1096 / fj.01-0254fje.

27. Kauser S, Slominski A, Wei ET, Tobin DJ. Modulation of the human hair follicle pigmentary unit by corticotropin-releasing hormone and urocortin peptides. FASEB J. 2006; 20 (7): 882-895. doi: 10.1096 / fj.05-5257com.

28. Slominski AT, Manna PR, Tuckey RC.Cutaneous glucocorticosteroidogenesis: Securing local homeostasis and the skin integrity. Exp Dermatol. 2014; 23 (6): 369-374. doi: 10.1111 / exd.12376.

29. Redvers RP, Li A, Kaur P. Side population in adult murine epidermis exhibits phenotypic and functional characteristics of keratinocyte stem cells. Proc Natl Acad Sci U S A. 2006; 103 (35): 13168-13173. doi: 10.1073 / pnas.0602579103.

30.Vukelic S, Stojadinovic O, Pastar I, et al. Cortisol synthesis in epidermis is induced by IL-1 and tissue injury. J Biol Chem. 2011; 286 (12): 10265-10275. doi: 10.1074 / jbc.M110.188268.

31. Pastar I, Stojadinovic O, Yin NC, et al. Epithelialization in Wound Healing: A Comprehensive Review. Adv wound care. 2014; 3 (7): 445-464. doi: 10.1089 / wound.2013.0473.

32.Shi Y, Shu B, Yang R, et al. Wnt and Notch signaling pathway involved in wound healing by targeting c-Myc and Hes1 separately. Stem Cell Res Ther. 2015; 6 (1): 120. doi: 10.1186 / s13287-015-0103-4.

Cortisone injection for knee pain

There are many reasons why you may have knee pain. If it persists, a cortisone injection is one treatment option.This type of injection is also done in other areas of the body, always in joints such as the shoulder, wrist, spine, thigh, elbow, ankle, or even the small joints of the feet and hands. Before getting a cortisone injection for knee pain, there are a few important things to know.

What’s in a cortisone injection?

Although they can vary, most cortisone injections have two main components. A corticosteroid or similar medication will hopefully provide your knee with long-term pain relief, but this relief does not come overnight.Most injections also include a local anesthetic to provide instant relief, at least for a while.

Causes of knee pain that may require injection

As mentioned, knee pain can occur for several reasons. Cortisone injections for knee pain are commonly used to treat arthritis, including reactive, psoriatic, rheumatoid, overuse knee injuries, work-related injuries, and osteoarthritis.They can also help treat tendonitis, gout, and bursitis.

For arthritis, doctors usually suggest cortisone injections only if three or fewer joints are severely affected. Your doctor is unlikely to give you injections for more joints all at once and is likely to suggest a different treatment.

Can anyone get a cortisone injection for knee pain?

Both children and adults can be injected with cortisone to relieve knee pain.However, there are a few situations in which you should not get an injection, or your doctor may suggest that you wait.

If you are allergic to the components of the injection, you will not be able to give it safely. Your doctor may also advise you to avoid hydrocortisone and certain other cortisone injections if you have a family history of manic depression or depression. If you were recently vaccinated, have an infection, are pregnant, or have potential contact with a sick person with measles, chickenpox, or shingles, you will have to wait for the shot.

What to expect from a cortisone injection

Results after cortisone injection vary from person to person. Some people may not feel at all relieved. For most people, the inflammation and pain get worse within two days of the injection. After that, the inflammation and pain should begin to diminish, and you can enjoy this relief for several months. Pain relief usually lasts six to 12 weeks.

Procedure for receiving a cortisone injection

Before giving you a cortisone injection, your doctor will clean the injection site.A fluoroscopy, which is a type of X-ray or ultrasound, will help guide the needle. You should only feel a little pressure when the doctor inserts the needle. There should not be significant discomfort, although

After the injection, you will most likely have to stay in the doctor’s office for at least half an hour to monitor for side effects. This is also a precautionary measure, as the numbness caused by the local anesthetic will make it difficult for you to walk.

The next few days

For a few days after your cortisone injection, you will be asked to relax.You should do your best not to stand on your feet, as you do not want to burden this area. It is best if you also avoid hot baths and baths, but you can shower with peace of mind. If knee pain recurs a few days after the injection, use ice instead of heat.

Common side effects

The most common side effects are swelling and pain at the injection site, which should go away within a few days. Bruises on the knee are also possible, which should also disappear after a few days.

How often can cortisone injections be given

It is important to know that cortisone injections should not be given too often. The Mayo Clinic recommends that injections should not be given more than three to four times a year, or more than six weeks apart.

Another factor to keep in mind is that cortisone injections can become less effective if used more often, and they tend to be most effective the first time.

Potential side effects

The limited use of cortisone injections is due to the risks associated with them, especially because they increase the more the more injections you receive and the higher the dose of the drug they contain.Typical doses of hydrocortisone, a common cortisone injection, are 5 to 50 milligrams.

We have already touched on the common side effects. Some less common side effects may include joint infection, cartilage damage, death of nearby bones, nerve damage, osteoporosis, weakening of tendons, skin discoloration from injection, thinning of the skin from injection, and / or temporary high blood sugar, facial flushing. or increased inflammation and pain from the injection.It is also possible that hydrocortisone injections weaken the immune system, increasing the risk of infections.

Call us today for a consultation

Our medical staff has extensive experience in the diagnosis and treatment of knee injuries and pain. Our multidisciplinary practice in Brooklyn, NY is staffed by the following specialists: orthopedist, neurologist, pain management physician, physical therapist, chiropractor, and others.

We accept accident insurance, workers compensation, medical obligations and most major health insurance plans.

NEW : Telemedicine consultations are now available. Call (718) 395-9781 to schedule a consultation from the comfort of your home. It is possible to make an appointment on the same day.

Additional sources:

https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794

https://www.webmd.com/osteoarthritis/features/injections-for-osteoarthritis-pain

https: // www.nhs.uk/medicines/hydrocortisone-injections/

90,000 What are the most common side effects of cortisone?

Oral and injectable cortisone are common treatment options for a number of medical conditions, but like many other medications, they also have a number of side effects. Some of the most common oral side effects of cortisone are stomach upset and increased appetite. When cortisone is injected into the body, it often causes discomfort.It can also lighten the skin tone and weaken the surrounding tendons. Some patients who are injected with cortisone may also experience flushing and high blood sugar.

Cortisone is a corticosteroid hormone and can be taken orally or injected directly into the body. Because this medication can suppress the immune system, doctors often prescribe it to patients with autoimmune diseases or recent organ transplants. When injected into joints, cortisone also helps reduce inflammation.

Oral side effects of cortisone often include nausea, vomiting, and diarrhea. Patients who take oral cortisone may also notice that their appetite has increased and over time they may also begin to gain weight. Headaches and dizziness are also side effects of oral cortisone.

Injected cortisone can also cause a number of side effects. For example, patients who are injected with cortisone in their joints often experience pain and swelling at the injection site.These side effects of cortisone can last for several hours and can be lessened with pain relievers, anti-inflammatories, and ice packs.

Dark-skinned people who receive cortisone shots sometimes notice that their skin becomes very light at the site of the cortisone injection. Cortisone can also weaken tendons in joints. Sometimes, these tendons can also stretch or rupture after a few shots of cortisone.

Most patients who receive cortisone injections will also find that the skin on their face becomes reddened and hot.These side effects of cortisone can last from hours to days. Elevated blood sugar is another of the most common side effects of cortisone.

Although rare, allergic reactions can also occur after taking cortisone or cortisone injections. This can be a serious medical emergency and usually requires immediate medical attention. Patients who are allergic to cortisone may experience a number of side effects.

Hives are one of the most common signs of cortisone allergy. These are usually red, itchy patches on the skin. Although they can appear anywhere on the skin, they are usually more common at injection sites. Patients with a cortisone allergy may also experience swelling in the face as well as in the mouth and throat. This swelling can cause the airways to close, which can make breathing difficult. In some severe cases, cortisone allergy can be fatal.

OTHER LANGUAGES

rupg_Le terapie non chirurgiche – Bioimpianti

In all cases of arthrosis, therapy depends on the severity of the symptoms and the degree of cartilage wasting.

Pain relievers and anti-inflammatory drugs are used to relieve symptoms in the early stages of the disease. However, the side effects caused by these drugs prevent their use for a long time.

A healthy lifestyle, including exercises that do not overload the limb (exercise bike, swimming, water gymnastics), allows you to maintain good muscle tone and slow down the development of arthritis.In particular, keeping the quadriceps femoris toned helps to delay the onset of instability. Overweight patients need to lose weight in order to reduce the stress on the joint (and thereby slow down cartilage degeneration), reduce the risk of complications from arthroplasty, and speed up recovery from surgery.

Physiotherapy treatments such as TENS (transcutaneous electrical nerve stimulation), laser therapy and ultrasound therapy are rarely effective.

Infiltration therapy relieves symptoms and slows down disease progression.For her, two categories of drugs are used – hyaluronic acid and cortisone derivatives. Infiltration of cortisone is indicated in cases of severe pain. Inside the joint capsule, the drug acts against inflammation, reducing or eliminating pain. Intra-joint administration of cortisone has a degenerative effect on cartilage if used for too long, so it is contraindicated in young patients. Infiltration of with hyaluronic acid is indicated in the case of the initial stage of the disease, when cartilage degeneration has just begun.

REFERENCES

1. Knoop J, Steultjens MP, van der Leeden M, van der Esch M, Thorstensson CA, Roorda LD, Lems WF, Dekker J. Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Cartilage. 2011 Apr; 19 (4): 381-8.
2. Vaquero J, Calvo JA, Chana F, Perez-Mañanes R The patellar thinning osteotomy in patellofemoral arthritis: four to 18 years’ follow-up. J Bone Joint Surg Br. 2010 Oct; 92 (10): 1385-91.
3.Feeley BT, Gallo RA, Sherman S, Williams RJ. Management of osteoarthritis of the knee in the active patient. J Am Acad Orthop Surg. 2010 Jul; 18 (7): 406-16.

90,000 Coronavirus: Asthmatics at High Risk? | World Events – Estimates and Forecasts from Germany and Europe | DW

Elderly people, as well as patients with chronic diseases, are at increased risk in the context of the coronavirus pandemic. It is known that the SARS-CoV-2 virus primarily infects the lower respiratory tract, including the lungs.This causes increased concern for asthmatics, who fear if they become infected with a particularly severe course of the COVID-19 disease.

To make matters worse, the use of common anti-asthma drugs increases the likelihood of infection.

How dangerous are cortisone medications?

For the treatment of asthma, aerosol preparations are most often used, and in severe cases, cortisone-based tablets are also used. Cortisone has an anti-inflammatory effect and reduces bronchial sensitivity, which is increased in asthma.This, according to some reports, leads to a weakening and suppression of the human immune system.

Inhaler for children with asthma

In order to calm asthmatics, German pulmonologists decided to come up with a special clarification, in which they indicated that the risk of asthmatics becoming infected with coronavirus does not increase if they continue to take medications regularly and do not stop doing it without consulting their doctor a doctor. If a patient with asthma is not feeling well, the doctor may choose to increase or decrease the dose of cortisone at their discretion.

Expert opinions differ

But there are other opinions on this matter. Some experts are critical of asthma therapy with inhaled corticosteroids.

Christian Drosten

For example, Christian Drosten, the chief virologist at the Berlin University Hospital Charite, recommends that asthmatics consult their physicians and find out if it is better to replace cortisone-based drugs with drugs that have less effect on the human immune system.

But, since the relationship between cortisone and immunity has not yet been scientifically proven, experts from the German Society of Pulmonologists and Respiratory Specialists (DGP) still consider classical inhalation therapy to be optimal. According to them, spontaneous cessation of medication and switching to another therapy may be significantly more dangerous than the yet unproven increased risk of contracting the SARS-CoV-2 coronavirus.

DGP believes that only patients with severe asthma and regular cortisone pills are at increased risk.For asthmatics, who only occasionally resort to aerosols with cortisone, they recommend doing this regularly – so that the airways remain open and there are no attacks of coughing or choking. If such aerosols do not help, you should consult your doctor.

Need Does Asthmatics Additional Protection Measures ?

In general, people with chronic respiratory diseases find it more difficult to resist viruses because their lungs are already weakened.

But according to the chief pulmonologist at the University clinic in Munich, Professor Rainald Fischer, asthmatics are not so much at increased risk, since in most cases, inflammation of the mucous membrane of their bronchi is an allergic reaction, which, like usually does not lead to pneumonia. At the same time, Fischer draws attention to the fact that it is generally problematic for “lungs” to wear effective protective masks with filters of the FFP3 type, since they make breathing difficult.

And without SARS-CoV-2, viruses and bacteria can lead to inflammatory processes in the bronchi and lungs of a person. Therefore, many doctors strongly advise asthmatics to be vaccinated against influenza and pneumococcal infections. And asthmatics, like all other patients with chronic respiratory diseases, must especially carefully observe generally accepted standards of hygiene and maintain a safety distance between people of at least one and a half meters.

See also:

• Where in Germany are protective masks sewn

  In Germany, there is still no mandatory requirement to wear protective masks in public places, as, for example, in the Czech Republic.However, the residents of the country are preparing for this scenario, and are also organizing the production of simple masks for medical institutions and other services in need of them. Such models with replaceable filters are now knitted by the artist from Hanover Manscha Friedrich.

• Where in Germany they sew protective masks

  The props of some German theaters have now switched to sewing simple masks. All performances and rehearsals were canceled anyway due to quarantine measures.Theatrical cutters and seamstresses quickly mastered this simple process. In Berlin, only one Central Service Workshop for opera stages produces 700 masks per week.

• Where protective masks are made in Germany

  This photograph was taken at the State Theater in the Brandenburg city of Cottbus. The first such protective masks were handed over from here to the local fire and rescue service and the Red Cross at the end of March. A total of twelve seamstresses work here in two shifts.

• Where protective masks are made in Germany

  This picture was taken in Halberstadt (Saxony-Anhalt) in the general theater workshop in North Harz. It produces 60 masks a day – in particular, for employees of savings banks, city officials and supermarket sellers.

• Where in Germany they sew protective masks

  Such a solemn ceremony of handing over the first batch of “theatrical” masks to the doctors of the local university hospital was staged at the State Theater in Mainz (Rhineland-Palatinate) – right on the main stage.

• Where protective masks are made in Germany

  During normal times, Petra Warnecke sews fashionable leather clothes, which he sells in weekly markets in different parts of Hanover (Lower Saxony). Markets in Germany, by the way, now continue to work, but you can only trade in food products. At her usual stand, Petra Varnecke offers such masks of her own work – in exchange for donations.

• Where in Germany they sew protective masks

  Designer Pia Fischer from Berlin now also sews masks instead of fashion accessories and clothes.Part sells directly through the window of his store. She started doing this after a friend from the nursing service complained about the lack of masks at work. She provided for a friend, and now she helps others.

• Where protective masks are made in Germany

  This photo was taken in the Bavarian city of Würzburg, where such masks began to be produced from materials intended for the production of mattresses. Wegerich has plenty of stocks.The model of the mask was quickly developed here in collaboration with specialists from the social service.

• Where in Germany they sew protective masks

  In addition to the production of protective textile masks in Germany, they also organize the production of protective screens, the necessary parts for which are printed on 3D printers …

• Where in Germany they sew protective masks

  So screen protectors look ready-made – assembled from printed parts and regular transparencies for desktop projectors.This photograph was taken at the University Hospital Freiburg, Baden-Württemberg.

  Author: Maxim Nelyubin

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