Cortisone therapy for joint diseases

Cortisone injection, corticoid crystal suspension, intra-articular cortisone injection, risks of intra-articular injection, betamethasone, dexamethasone, triamcinolone

Introduction

Glucocorticoids, colloquially known as “cortisone“, are very effective drugs in the treatment of inflammation of all kinds and the pain associated with it. In inflammatory joint diseases, they are injected directly into the joint in the form of so-called crystal suspensions.

Side effects of cortisone therapy

In principle, any injury to the body, even a joint injection, carries the risk of bacterial infection (septic arthritis). For this reason, your doctor will only perform the procedure under strict hygiene measures. The risk of infection is low if the procedure is performed professionally.

Depending on how well the region to be treated is accessible to the syringe, injuries to the surrounding tissue cannot be ruled out. Blood vessels can be injured as well as nerves, tendons and cartilage surfaces. It can also happen that the syringe misses its target and the injection is injected into surrounding areas.

Injection of cortisone directly into tendon tissue or fatty tissue, for example, is harmful because the affected structures can regress. When injected into tendon tissue, there is therefore a risk of tearing the tendon. In addition, it is conceivable that the injected active substance is distributed from the joint through the puncture channel into surrounding tissue, causing undesirable side effects.

For this reason, the joint should rest after the operation! Occasionally skin changes occur around the injection site. Sometimes a single treatment is not sufficient to relieve the pain.

However, a renewed injection of cortisone increases the risk of side effects. For this reason, especially in older patients, multiple injections should only be given after carefully weighing up the benefits and risks. Compared to systemic therapy with cortisone, local therapy in the form of injections has a lower risk of side effects.

In systemic therapy, cortisone is usually taken in tablet form or administered intravenously. The cortisone is then absorbed through the digestive tract and reaches all parts of the body via the blood. Therefore, side effects can then occur in a generalized manner, i.e. everywhere on the body.

When cortisone is injected with a syringe into a very specific part of the body, the dose is usually small and its distribution into the surrounding tissue is limited. This also reduces the risk of suffering side effects. However, if cortisone injections are frequently used in high doses, this can ultimately lead to systemic effects.

In severe cases, the systemic effect may result in the body appearing bloated and redistributing body fat. There may also be a so-called full moon face and thin skin (also known as Cushing’s syndrome). However, these systemic side effects are only to be feared if the dosage is high and frequent. At lower doses, as is the case with local injections, slight systemic side effects may occur, such as an increase in blood sugar levels, a feeling of warmth and reddened cheeks.