Side effects of cortisone injections
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Side Effects of Cortisone Injections
Cortisone injections are commonly used to treat various musculoskeletal conditions, including arthritis and tendinitis. While they can provide significant relief from pain and inflammation, they are also associated with a range of potential side effects. This article synthesizes the findings from multiple research studies to provide a comprehensive overview of the adverse effects of cortisone injections.
Systemic Side Effects of Cortisone Injections
Hypothalamic-Pituitary-Adrenal Axis Suppression
One of the most studied systemic effects of intra-articular corticosteroid injections (IACI) is the suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Serum cortisol levels typically decrease within hours after the injection, reaching their lowest point within 24-48 hours. Recovery to baseline levels can take anywhere from 1 to 4 weeks, depending on the type and dose of the corticosteroid and the number of joints injected . This suppression can lead to a blunted response to adrenocorticotropic hormone stimulation in some patients, particularly following injections of methylprednisolone acetate .
Blood Glucose Levels
Cortisone injections can cause a transient increase in blood glucose levels, particularly in patients with controlled diabetes. This spike in blood glucose can last for a few days, with peak levels reaching around 300 mg% 14. This effect necessitates careful monitoring in diabetic patients to avoid complications.
Immune Function and Infection Risk
Corticosteroids are known to reduce immune function, which can increase the risk of infections. This is particularly concerning for patients undergoing rotator cuff repair, as pre-operative corticosteroid injections have been associated with a higher risk of post-operative infections 34. The risk is especially high if the injection is administered within a month prior to surgery .
Local and Musculoskeletal Side Effects
Cartilage Toxicity and Tendon Health
Cortisone injections can be toxic to articular cartilage, potentially leading to long-term joint damage . Additionally, they have been linked to adverse effects on rotator cuff tendons, including an increased risk of tendon rupture and the need for revision surgery if administered within six months of rotator cuff repair .
Avascular Necrosis
High-dosage corticosteroid therapy has been associated with avascular necrosis of the femoral and humeral heads, a condition where bone tissue dies due to a lack of blood supply. This can lead to severe joint pain and disability .
Steroid Flares
Steroid flares, characterized by increased pain and inflammation at the injection site, can occur due to the crystallization of cortisone within the lipid bilayer of cell membranes. This crystallization disrupts membrane integrity, leading to painful side effects .
Dermatologic and Other Systemic Effects
Skin Reactions
Dermatologic side effects, such as severe acneiform rashes, have been reported in patients following intra-articular corticosteroid injections. These reactions are relatively rare but can be severe, particularly in children with juvenile idiopathic arthritis .
Other Systemic Effects
Other reported systemic side effects include insomnia, Cushing-like features, and visual disturbances such as central serous chorioretinopathy 78. These effects highlight the need for careful patient monitoring and selection when considering cortisone injections.
Conclusion
While cortisone injections can provide significant short-term relief from pain and inflammation, they are associated with a range of potential side effects. These include systemic effects such as HPA axis suppression and increased blood glucose levels, as well as local effects like cartilage toxicity and tendon damage. Physicians should weigh these risks against the benefits when considering cortisone injections for their patients and monitor for adverse effects closely.
Sources and full results
Most relevant research papers on this topic
Adverse impact of corticosteroid injection on rotator cuff tendon health and repair: A systematic review.
Pre-operative corticosteroid injections in rotator cuff patients can increase the risk of revision surgery after rotator cuff repair, and should be withheld if a rotator cuff repair is planned within six months.
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