Steroid Injections in Treating Arthritis

Steroid injections are commonly used in musculoskeletal conditions such as osteoarthritis. However, they can also play an important role in managing joints affected by inflammatory arthritis such as Rheumatoid arthritis or psoriatic arthritis or conditions such as gout.

Through complex processes, steroids have powerful anti-inflammatory effects, which help to reduce the levels of inflammation of the joint in question. Pain levels will improve with the reduction in inflammation. The mechanism of action leads to a decrease in synovial blood flow and the number of leukocytes, as well as the release of inflammatory mediator (1). Joint inflammation in knee OA is associated with progression of cartilage damage, therefore steroid injection might reduce disease progression.  

As indicated above, inflammation causes swelling and pain. Steroid injections, therefore, can reduce swelling of joints and other structures affected by inflammation. This will help with mobility and function.

It is well-known that steroid injections have a temporary effect, but this can last for a good number of months. It is therefore not uncommon that for those with self-limiting conditions such as: Frozen shoulder, certain degrees of tendinopathy and bursitis etc. a single steroid injection might be sufficient for the problem to disappear completely and for it to never return. The reason for this is that natural healing will take place, and by the time that the steroid has stopped working the person has recovered naturally.

Of course, for more chronic conditions with significant structural damage, such as significant degrees of osteoarthritis, the benefit of the steroid injection is often more temporary in nature although from experience I have found that in a good number of cases the steroid helps to settle the acute pain for months at which point the joint might have settled naturally in a state where pain is no longer a significant issue despite the fact that the degenerative changes present are still unchanged.

In the case of osteoarthritis if someone does require repeat injections, they may well benefit from hyaluronic acid injections, which contain hyaluronic acid (a natural component of joint fluid). These injections contain a synthetic form of hyaluronic acid and help to lubricate the affected joint.

Rastogi, A.K.; Davis, K.W.; Ross, A.; Rosas, H.G. Fundamentals of Joint Injection. Am. J. Roentgenol. 2016, 207, 484–494.