Articles
Steroids for the treatment of osteoarthritis
These articles are independently commissioned and the author may express opinions which are not necessarily those of Smith & Nephew limited.
Intra-articular (injected directly into the joint) corticosteroids remain widely used for relief of symptoms of osteoarthritis (OA). They have been successfully used for over 40 years and you may even have already had one or more of steroid injections into your joint, but what are steroids?
This article will help you understand more about the various treatments which are being offered to you.
Steroids are synthetic drugs also called corticosteroids, that closely resemble cortisol, a hormone that your body produces naturally. Steroids work by decreasing inflammation (swelling) and reducing the activity of the immune system. They are used to treat a range of diseases which are inflammatory (that cause painful swelling). In situations where the inflammation is causing organ damage steroids can be very effective and even life saving, but this article looks only at their role in the treatment of OA.
How Are Steroids Given?
Steroids can be given topically (as a cream), by mouth (tablets) or by injection. In osteoarthritis they are normally injected directly into a joint but if the OA affects many joints they can be offered in tablet form to be taken orally. This is not so common because although effective, steroids given as tablets can have significant side effects over the long term.
How do Steroids Work?
Injected steroids work by suppressing the immune response that produces the inflammation. Inflammation is part of the body’s defence system of chemicals and white blood cells which fight off infection, foreign materials and viruses.
When this system is active it can cause localised swelling, redness and of course pain. If this happens in a joint it can cause significant immobility and loss of function in that area of the body leading to disability.
Are Steroids Always Used to Treat Osteoarthritis?
Steroids are not always used because OA has a range of symptoms and is often not associated with inflammation as described above.
Most OA symptoms consist of pain, stiffness and crepitus (a grinding feeling).
However some sufferers of OA find that the cycle of OA symptoms can included periodic episodes of inflammation, also called flares. They can occur following excessive activity or can be random and last a few days to many weeks.
The joint becomes hot swollen and very painful to move. In this situation steroids may well be suggested by doctors as a way of controlling the pain and reducing the inflammation. However, clinical trials have shown that the average length of pain relief from a steroid injection is 1-5 weeks so for most patients they are not a long term solution for the treatment of OA pain.
Are There Any Side Effects From Steroid Injections?
Like all medication there can be side effects but they are not common with steroids injected directly into the joint a couple of times a year and are generally safe. Post injection pain is quite common which generally settles down after a few days.
If you have a bacterial infection in any part of the body from the OA then steroids may not be appropriate for you as they affect the body’s immune system and reduce the ability to fight off infection especially if given orally. Always contact your doctor if you have questions about your personal medication.
How Often Can Steroids Be Injected Into The Joint?
This varies according to individual patient needs - the published guidelines of th4e American College of Rheumatology (ACR) suggest no more than three steroid injections per year.