Cortisone injections, also called corticosteroid or steroid injections, are shots that can alleviate pain and decrease inflammation in people with rheumatoid arthritis (RA). Corticosteroids are anti-inflammatory medications that can be given as injections, creams, oral medications, and more.

Steroid injections may be used to treat other types of pain, including back pain or tendinitis. Cortisone injections to relieve joint pain are different from anabolic steroids, which athletes may take to boost their performance.

When and How Are Cortisone Injections Used?

Doctors recommend cortisone injections on a case-by-case basis. Your doctor will consider your age, fitness level, and current medications before recommending cortisone injections for RA.

Steroid injections for people with RA are often part of a larger treatment plan. Your treatment plan may also include pain medications, other anti-inflammatory drugs, occupational therapy, physical therapy, or other therapy devices like braces and canes.

Your doctor may recommend a cortisone shot during a severe flare-up. It can help alleviate some signs and symptoms of RA, including chronic pain; achiness, stiffness, or swelling of a joint; or general fatigue and weakness.

Sometimes a doctor will recommend a steroid shot to boost the effectiveness of a disease-modifying antirheumatic drug (DMARD) or other medication. A steroid shot can give faster pain relief while someone waits for a DMARD or a biologic to begin working fully.

In some cases, a doctor may want to give a large dose of corticosteroid medication straight to the most affected area, like the joints of someone’s hands, knees, or wrists.

Where Are Cortisone Shots Given?

If a doctor wants the cortisone to treat the person’s entire body, they will inject it into a person’s vein (intravenous) or muscle (intramuscular). If a doctor wants the cortisone to treat a specific body part or area of the body, they will inject the medication into a joint (intra-articular), into a bursa (sac for lubrication that sits between specific tendons and bones), around a tendon, or into another area of soft tissue.

Who Is a Candidate for Cortisone Shots?

Most children and adults with RA can get cortisone injections.

Before receiving a cortisone shot, a person needs to be free of infection. Also, the joint or joints cannot be severely damaged. If they are, the injection will probably not help.

Also, a person must not have a bleeding condition or be on blood thinners. Cortisone injections can cause bleeding at the injection site. Because of this, health care providers use extreme caution when injecting a person with RA who also has a bleeding problem or is taking a blood thinner.

In addition to the above, before having a cortisone injection, tell your health care provider if you:

• Have experienced an allergic reaction to cortisone or another medication
• Have a history of depression or bipolar disorder, either personally or in your family
• Are currently attempting to get pregnant, already are pregnant, or are currently breastfeeding
• Recently have come in contact with a person with measles, shingles, or chickenpox, unless you are certain you are already immune to these diseases
• Have recently had any vaccinations or plan to get one soon

Any of the above scenarios may mean you are not eligible for a cortisone injection. However, please talk with your doctor so they can decide whether an injection for RA is right for you.

How Does a Doctor Give a Steroid Injection?

Typically, a specialist like a rheumatologist gives cortisone injections. Cortisone shots can usually be given in a doctor’s office.

During your visit, your doctor may request that you put on a gown. Then, they will position you so that they can easily treat your affected joint and disinfect the injection site.

Your doctor may use a local anesthetic to numb the affected area. They may also use a specific kind of X-ray or ultrasound to help them guide the needle to the correct spot.

Most people will feel mild pressure when the needle is inserted. Tell your doctor if you have more than slight pain. Once the needle is in the correct position, your doctor will inject the medication into the area.

When Can a Person Expect Pain Relief From a Steroid Injection?

Cortisone injections often lead to a temporary increase in inflammation and pain. This can last up to 48 hours after the shot. After 48 hours, the pain and inflammation caused by your RA should decrease.

According to the Cleveland Clinic, it may take up to seven days before the body responds to a corticosteroid injection. The positive effects from an injection typically last for two months, although they can also last longer.

Despite this delay, corticosteroids are still the quickest way to limit inflammation in the body. It is important to note, however, that injections are not a permanent fix for RA.

How Often Can You Get a Cortisone Shot?

Cortisone injected too often into the same part of the body can lead to weak tendons, ligaments, and bones.

Local injections should not be given more than once every three or four months. Whole-body injections should not be given more than six times per year. This helps to decrease the risk of potential side effects from injections. It also helps to decrease the risk of a weakened immune system from prolonged cortisone use.

Side effects from large doses and repetitive injections include:

• Bone weakening
• Cartilage damage
• Joint infection
• Nerve damage
• Skin or tissue thinning at the injection site

People who use other corticosteroid drugs like prednisone or a steroid inhaler should have either fewer injections per year or lower doses per injection. This helps to decrease the risk of any side effects.

What Happens if Steroid Injections Do Not Work?

If someone with RA gets a cortisone injection and they do not find much pain relief, they should not receive further injections. Someone with RA should only get repeat cortisone injections when they are getting significant pain relief for weeks to months.

If cortisone shots do not work for you, other treatment options may include:

• DMARDs, such as methotrexate (Otrexup) or sulfasalazine (Azulfidine)
• Biologics, such as etanercept (Enbrel) or infliximab (Remicade)
• Nonsteroidal anti-inflammatory medications, either over the counter or prescription
• Rehabilitation therapies such as aerobic exercise, stretching, heat therapy, ice therapy, or electrical stimulation

It is important to note that there is often a wearing-off effect when it comes to steroid injections. One myRAteam member stated, “I’ve been getting cortisone injections in my knees every four months for about five years. They have been wearing off a little sooner each time.”

If you receive steroid injections for many years, you should anticipate this wearing-off effect. If you experience it, talk with your doctor for other treatment options for your RA.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 185,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Have you received cortisone injections for your rheumatoid arthritis? If so, what was your experience? Share your story in the comments below, or start a conversation by posting on your Activities page.