Cortisone injections for knee osteoarthritis

Health Professional

"My doctor wants to give me a cortisone injection in my knee for my osteoarthritis. That's just a short-term fix, isn't it? Won't the pain just come back?"

Knee pain from osteoarthritis (OA) can range from mild to severe. There are several treatments available for osteoarthritis knee pain. These treatments range from nutritional interventions, supplements, and exercise all the way to injections and, potentially, even surgery.

In this blog, we'll talk about all of these options. But first, we'll talk about medication and injections for osteoarthritis pain relief.

Oral medications are one option. These medications range from simple painkillers (such as Tylenol, tramadol, and narcotics) to anti-inflammatory medications (such as Advil and Celebrex). The problem with any medication, of course, is that they all have the potential for side effects, and some of these side effects can be serious. There are also topical medications that are applied on the skin over the painful area and these are another potential option. In another blog, we'll talk about the different oral and topical medications for osteoarthritis.

Injections for Osteoarthritis Pain Relief
There are two basic types of injections for knee osteoarthritis. The first type is a series of hyaluronic acid injections. Hyaluronic acid is a substance that aims to restore the lost fluid within the joint. We'll talk much more about these types of injections in another blog. The other type of injection, and the one that we'll focus on here, is a corticosteroid injection. Steroids are very powerful anti-inflammatory medications. The pain from osteoarthritis generally comes from inflammation. By reducing the inflammation with steroids placed directly at the site of inflammation, the pain largely subsides.

But won't the pain return when the steroids wear off?
Yes, it will. That's why even if you feel great after receiving a steroid injection for knee osteoarthritis, you will also have to address the underlying biomechanics of the knee. I tell my patients to think of topical medications, oral medications, and injections into the knee as tools that offer windows of opportunity during which they should be able, with my help, to get into an appropriate, structured exercise program designed to alter and correct their biomechanics.

The purpose of the exercise program is to unload the knee so that the pain and inflammation do not return once they stop taking their prescribed medication and/or the effects of the injection wear off. In the case of a steroid injection, the injection, when it works, typically provides about 3 to 4 months of relief. This is a substantial window of opportunity to work on strengthening the knee joint.

Impressive scientific evidence suggests that by strengthening the muscles around the knee joint (particularly the quadriceps in front of the thigh), the pain and inflammation associated with knee osteoarthritis can be greatly diminished Why does this work? Essentially, strengthening the thigh muscles takes the pressure off the knee joint. And once the pain is gone, by keeping the muscles strong, the inflammation and pain are much less likely to return.

But my knee hurts-how can I exercise?
While it is okay to exercise with some muscle discomfort, one should not exercise through joint pain. When osteoarthritis knee pain is significant enough to make exercise difficult, doctors have a variety of effective tools to take away the pain, including oral medications and the other remedies I mentioned above.

In addition to supervised, targeted exercise, it may also be worth considering pursuing an anti-inflammatory diet and taking a few supplements. You can also read more about all this in my book The Arthritis Handbook: Improve your health and manage the pain of osteoarthritis (Diamedica, 2008).

Things to Consider About Steroid Injections

There are a few additional points that you should know about steroid injections for knee osteoarthritis. First, while the initial injection is often quite effective and may last for 3 to 4 months, subsequent injections tend to be less effective. Most doctors will only inject a single joint 3 or 4 times over the course of a two-year period because steroids may cause further deterioration in the joint and surrounding structures.

Although generally well tolerated, there are risks involved with a steroid injection. Infection and bleeding are risks with any injection. Though rare, a "flare" of increased pain after the injection can also occur. This flare generally subsides within 3 days. If this happens to you, call your doctor. Steroid injections can also raise your blood glucose level for a few days so if you have diabetes, you should discuss this potential risk with your doctor. There are other risks involved. For example, if you are on a blood thinner like warfarin, you may need to discontinue it prior to the injection.

I urge you to use the information here as a springboard to a thorough discussion of all your therapeutic options, including their potential risks and benefits, with your doctor. Naturally, only your personal doctor can know if a steroid injection or other treatment is right for you.

Thank you for taking the time to read this blog. I wish you the best of health, because with good health all things are possible.