Monday, July 15, 2013

The Pros and Cons of Arthritis Injections

In the treatment of musculoskeletal problems, cortisone injections may be extremely effective. Also called corticosteroid injections, they provide a focused anti-inflammatory effect aimed at providing pain relief for patients that is coming from a joint problem, such as osteoarthritis, or a soft tissue problem, such as lateral epicondylitis (tennis elbow).

The medication in a steroid shot contains some of the same hormones that the human adrenal glands produce. These hormones, corticosteroids, perform vital functions in the body, such as being released and providing anti-inflammation when stress is experienced.

These injections into either joints or soft tissues provide pain relief, but it is not permanent. The effects wear off after a few weeks to months, and it may actually take a few days for the pain relief to kick in. Typically some numbing medicine is included with the steroid to give immediate relief.

Patients frequently ask if the cortisone will help with cartilage restoration. Steroid injections are not disease altering treatments, they are simply symptom altering and meant to decrease pain.

So what are the benefits of a steroid injection?

1. Pain relief - This is the main benefit, as the injection of steroid doesn't alter the course of arthritis. But it does make life more tolerable by decreasing pain for what may be quite a few months.

2. Low Risk - Compared with surgery for a musculoskeletal condition, an injection maintains a much lower risk profile.

3. Low Cost - Also compared with surgery, an injection cost exponentially less.

4. Focused Injection - The steroid is injected into either a joint which is a confined space or into a soft tissue area where the medication stays predominantly local.

5. Outpatient - The injections are done either in the doctor's office or as an outpatient procedure. No overnight stays necessary.

6. Can delay the need for surgery - If a patient is in his 50's and has terrible osteoarthritis, doing a knee replacement may only last for 15 years. This may lead to the need for a revision surgery which typically has a less satisfactory result. So the injections may provide an impressively tolerable delay for years.

7. Can be placed in multiple joints - If a patient has pain and arthritis in multiple joints, such as the knees, shoulders, and spine, steroid injections may be placed in a few joints (with appropriate care not too many at once)

What are the risks of a steroid injection?

1. Temporary blood sugar elevation - this is most common in diabetics and may raise blood sugars temporarily for 24-48 hours. It would be unusual for this to be an actual clinical problem, but people should be aware of the potential temporary issue, especially diabetics.

2. Cartilage damage - It's unclear in humans if this is clinically relevant. In animal studies there has been shown cartilage alterations with repetitive injections. The key here is moderation with the amount of injections administered to each joint.

3. Adrenal gland suppression - this type of complication may occur with oral steroid medication on a repetitive basis, it would be extremely unusual for a focal steroid injection to end up with this complication.

4. Infection - with appropriate sterile technique obtaining an infection after a steroid injection is rare, much less than 1%. Prophylactic antibiotics are not necessary.

For most individuals, cortisone injections represent an excellent pain relief option for musculoskeletal conditions. The key is moderation.

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