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Article by Nathan Wei, MD
Cortisone injections are an accepted part of care for certain types of arthritis. This article discusses some of the things you should know about them.
“Cortisone” is a term commonly used to describe an anti-inflammatory steroid medicine. These medicines – given by injection directly into a pain, inflamed joint- are often used to treat arthritis. The types of arthritis where these injections are used most often are rheumatoid arthritis (RA), osteoarthritis, gout, pseudogout, psoriatic arthritis, and ankylosing spondylitis.
If a patient has one or two… or even three inflamed joints, steroid injection can be useful. However, if a patient has many swollen joints, as can occur with rheumatoid arthritis, then steroid injection for all the swollen joints is not practical. In an inflamed joint though, removal of joint fluid and injection of steroid medication can alleviate pain and swelling almost miraculously!
Depending on the size of the joint, needle size will vary. For small joints, small needles; for larger joints, larger needles. Larger joints will also be the ones that will have joint fluid. A larger bore needle is needed so that fluid can be withdrawn.
Caution should be exercised. An inflamed joint should have the fluid withdrawn and cultured to ensure the joint is not infected. Injections of steroid too frequently (more than 3 times a year into the same joint), can cause side effects such as weakening of cartilage leading to osteoarthritis, and thinning of the skin. In addition, too much steroid given over an extended period of time can lead to osteoporosis. An injection, as with any invasive procedure, has the potential to cause infection so sterile technique must be observed.
If a patient with rheumatoid arthritis requires frequent steroid injection, then this is an indication that the background medication therapies are not doing their job. In patients with rheumatoid arthritis this may mean the need for higher doses of methotrexate or the institution of biologic therapy. In other words, steroid injections- at least in RA- are not the primary mode of treatment for the disease. Steroid injections are adjunctive therapies.
These injections should be administered by an experience rheumatologist or orthopedic surgeon. Ultrasound or fluoroscopy are imaging techniques that should be used to ensure accurate placement of the needle into the joint.
Informed consent is an important part of the injection process. The procedure should be explained to the patient. The patient should be provided with the alternatives to injection as well as a list of potential side effects.
About the Author
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html”>Arthritis Treatment