What are steroids?

Why are steroids prescribed?

What are the possible side-effects?

What are the risks?

What else should I know about steroids?

What are steroids?

Some steroids occur naturally in the human body. Man-made steroids act like natural steroids to reduce inflammation. They can be given in tablet form or as an injection. A steroid mixture can be injected into or around an inflamed joint to ease symptoms. It is known as a local injection because it acts in a particular area. A number of different steroids are available for injection. Some work quite quickly but for a relatively short time, while others are effective for longer but also take longer to start working.

What type of drug are steroids?

Steroids are a type of medicine, which can be given as tablets or injections. Steroid injections come in different formulations – some act very quickly, others are slower-acting but longer-lasting.

What do they do?

They reduce inflammation, which helps to ease pain and reduce stiffness.

How are they used for?

They are used for any inflammatory arthritis, and sometimes for severe osteoarthritis, for gout and conditions caused by calcium crystals, and for conditions affecting the muscles, tendons or other soft tissues.

How are they given?

They are given by your healthcare professional when necessary. This could be done locally into a joint (intra-articular injection), or into the tender area near a joint (soft tissue injection), or given systemically, via the oral route as tablets, intravenously, or by direct injection into a muscle (intra-muscular injection).

Are there any side-effects?

Side-effects are rare but can include a temporary flare-up of joint pain, infection, changes in mood and thinning of the skin.

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Why are local steroid injections prescribed?

A local steroid injection is given to reduce inflammation and pain within a joint. They are frequently recommended for people with rheumatoid arthritis and other types of inflammatory arthritis. They may also be recommended for osteoarthritis if your joints are very painful or if you need additional pain relief to help you through a special occasion or event, and for sudden painful attacks associated with gout or calcium crystal diseases. An injection into a joint is called an intra-articular injection, and given via this route minimizes the unwanted systemic side-effects of steroids.

If you have pain or inflammation near an affected joint, you will probably be given an injection into the tender area rather than the joint. These can be helpful for conditions such as tendinitis or bursitis. An injection near a joint but not actually into it is called a periarticular injection or soft tissue injection. An injection directly into a muscle is called an intramuscular (IM) injection.

Sometimes, steroid injections are also used for managing nerve entrapment syndromes such as carpal tunnel syndrome, performing nerve blocks to manage regional pain, or caudal epidural injection to manage chronic back pain or sciatica symptoms. A caudal epidural is performed by injecting steroid into the base of the spine, and is considered a safe, effective and well-tolerated procedure when performed by an experienced physician.

When and how do I have local steroid injections?

Your GP, rheumatologist, orthopaedic surgeon, rheumatology nurse or physiotherapist will choose the most appropriate steroid mixture and dose for your condition and symptoms. Most injections are quick and easy to perform.

If you have an injection into a joint, you should rest it, or at least avoid strenuous exercise, for the first 1–2 days. However, it is also important not to rest for too long. If you are having a course of physiotherapy, the physiotherapist may be keen to give more intensive mobilisation treatment after the injection, while your joint is less painful.

If the injection is very helpful, and other treatments are either unsuitable or less effective for you, it may be repeated if necessary.

How long do local steroid injections take to work?

Short-acting soluble steroids can give relief within hours and should last for at least a week. The longer-acting, less soluble steroids may take around a week to become effective but can ease your symptoms for two months or longer.

Sometimes you will be given a local anaesthetic with the steroid to reduce the discomfort of the injection, although the anaesthetic will not have any effect on the inflammation. If you do have a local anaesthetic with the steroid, your pain should be relieved within minutes but it will usually wear off within half an hour unless the anaesthetic selected is long acting.  You may have some numbness from the anaesthetic, which may last up to 24 hours.  If the joint is painful after the injection, simple painkillers like paracetamol should help.

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What are the possible side-effects?

Side-effects are very unlikely, though occasionally people notice a flare-up in their joint pain within the first 24 hours after an injection. This usually settles by itself within a couple of days, but taking simple painkillers like paracetamol will help.

The risk of side-effects is greatest with the stronger mixtures. The mildest mixture is hydrocortisone. Methylprednisolone and triamcinolone are stronger and tend to be less soluble (dissolve less easily), so they stay in your joint for longer.

Local steroid injections may sometimes cause facial flushing or interfere with the menstrual cycle. Other steroid-related side-effects are rare unless injections are given frequently (more than a few times per year).

Any treatment with steroids may cause changes in mood – you may feel very high or very low. This may be more common in people with a previous history of mood disturbance. If you are worried please discuss this with your doctor.

It is usual to see a rise in blood sugar levels for a few days after the injection if you have diabetes.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

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What are the risks?

Very rarely you may get an infection in the joint at the time of an injection. If your joint becomes more painful and hot you should see your doctor immediately, especially if you feel unwell. Injections can occasionally cause some thinning or changes in the colour of the skin at the injection site, particularly with stronger preparations. In very rare cases an injection of steroids into the muscle can lead to an indentation in the skin around the area.

Will it affect vaccinations?

You can have vaccinations after local steroid injections.

Can I drink alcohol while on local steroid injections?

There is no particular reason to avoid alcohol after local steroid injections.

Do local steroid injections affect fertility or pregnancy?

Single steroid injections should not affect fertility or pregnancy and are often useful treatments in this situation. However, if you are pregnant you should discuss this with your doctor before having a local steroid injection.

Do they affect breastfeeding?

Many women benefit from steroid injections while breastfeeding. Although small amounts of steroid may pass into the breast milk, this is very unlikely to be harmful to your baby. However, as always, you should discuss the risks with your doctor if you are concerned.

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What else should I know about local steroid injections?

The person giving you the injection may decide to use an ultrasound scan so they can find exactly where the inflammation is and inject the steroid into a precise spot. However, many injections can be given without the need for ultrasound.

You may want to arrange transport home after the injection, especially if you have had a local anaesthetic, because numbness from the anaesthetic can make it difficult to drive.

Injections can also temporarily improve some of your other joints, particularly those close to the injection site.

Are there any alternatives?

A number of other drugs are used in the treatment of arthritis. Your doctor or rheumatology nurse specialist will discuss these other options with you.

Can I take other medicines along with local steroid injections?

You can take other medicines with local steroid injections. However, you should mention to the person performing the injection if you are taking anticoagulants (blood thinners) to make sure that they are aware of this. It would be better to plan your injection ahead if you take warfarin so that if you need to adjust the dose, it can be ready for your appointment.

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