Local steroid injections

If you have an inflamed or swollen joint, or if you have pain or inflammation near a joint, your doctor may inject a steroid preparation into the affected area. It is known as a local injection because it acts only in that area.

• Injecting into a joint is called an intra-articular injection.
• Injecting near a joint but not actually into it is called a peri-articular injection (meaning 'near the joint') or soft tissue injection.

Steroids have a very powerful anti-inflammatory effect. There are several steroid preparations available. The mildest is hydrocortisone. Prednisolone, methylprednisolone and triamcinolone are stronger and tend to be less soluble, remaining in the joint for longer. The benefit from the stronger drugs is associated with a slightly increased risk of local side-effects.

Why are local steroid injections prescribed?

A local steroid injection is given to reduce inflammation, swelling and pain within a joint. In rheumatoid arthritis and related diseases there is often considerable inflammation in the joints, and so steroid injections are frequently recommended. Although osteoarthritis is mainly a ‘wear and tear’ condition, there may also be some inflammation present and so steroid injections may also be recommended for osteoarthritis.

A peri-articular or soft tissue injection is given to reduce pain and inflammation at that site. For instance, if you have tennis elbow your doctor may inject the tender area.

When and how do I have local steroid injections?

Your GP, rheumatologist, orthopaedic surgeon or rheumatology nurse specialist will choose the steroid preparation and the dose most appropriate to your needs.

S/he will also decide whether to inject a local anaesthetic at the same time. This does not reduce inflammation but will allow almost immediate temporary pain relief. However, most injections are quick and easy to perform and are associated with only a small amount of discomfort. Therefore local anaesthetic is not always used.

It is often recommended that a weight-bearing joint should be rested as much as possible for the first 1–2 days after an intra-articular injection. If this isn’t possible, you should at least avoid strenuous exercise for the first couple of days. If you are also having physiotherapy, the physiotherapist may be keen to give more intensive mobilisation treatment after the injection, while the joint is less painful.

How long do local steroid injections take to work?

The short-acting soluble steroids give relief within hours and should last for at least a week. The longer-acting, less soluble, steroids may take a few days to become effective but may give benefit for 2 months or longer. If an anaesthetic has also been given, pain relief should occur within minutes but it will usually wear off quickly (within half an hour, unless the anaesthetic selected is long acting).

There is general agreement that if an injection is very helpful, and other treatments are either inappropriate or less effective, the injection may be repeated every 3–4 months.

What are the possible risks or side-effects?

Side-effects are very unlikely but occasionally people notice a flare in their joint pain within the first 24 hours after an injection. This usually settles on its own within a couple of days.

Very rarely infection might be introduced into the joint at the time of an injection. Therefore if the joint becomes more painful and hot you should see your doctor immediately, especially if you feel unwell.

Occasionally with intra-articular and peri-articular injections some thinning or change in the colour of the skin may occur at the injection site. The risk of side-effects, particularly thinning of the skin, is greatest with the stronger preparations.

Local steroid injections may sometimes cause facial flushing or interfere with the menstrual cycle. Other steroid-related side-effects, as seen with steroid tablets, are rare unless injections are given frequently.

Any treatment with steroids may cause changes in mood – either elation or depression. This may be more common in people with a previous history of mood disturbance. If you have concerns please discuss this with your doctor.

What other treatments could be used instead of local steroid injections?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Other treatments including physiotherapy may also be beneficial. Your doctor will discuss these other options with you.

Will I need any special checks while on local steroid injections?

No special checks are required.

Can I take other medicines along with local steroid injections?

You may take other medicines with local steroid injections. However, if you are taking a drug that thins the blood (an anticoagulant) such as warfarin, it is less likely that you will be offered an injection because of the risk of bleeding into the joint. If you are taking anticoagulants you should mention this to the person giving the injection to ensure that s/he is aware of this.

What about immunisations?

You can have immunisations while on local steroid injections.

Can I drink alcohol while on local steroid injections?

There is no particular reason to avoid alcohol while on local steroid injections.

Do local steroid injections affect fertility or pregnancy?

Single injections of steroid should not affect fertility or pregnancy. However, if you are pregnant you should discuss this with your doctor before having a local steroid injection.

What about breastfeeding?

Joint injections are rarely needed when breastfeeding. However, if an injection is given small amounts of steroid could pass into the breast milk. While this is unlikely to be harmful to your baby, you should discuss the risks with your doctor.

Where can I obtain further information?

If you would like any further information about local steroid injections, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.

 

Remember to keep all medicines out of reach of children.

PLEASE NOTE: We have made every effort to ensure that this content is correct at time of publication, but remember that information about drugs may change. This page is for general education only and does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects that may be relevant in your particular case.

Our drug information is revised annually and published at the start of the year.