When cortisone was first developed in the mid-20th century, it was hailed as a miracle cure for rheumatoid arthritis. It reduced the pain and inflammation that crippled many patients. Doctors who prescribed it were seen as heroes by patients in pain.
Before long, though, the dark side of corticosteroids began to appear. Patients taking high doses for long periods of time experienced hypertension, diabetes, blood clots, cataracts, glaucoma, muscle weakness, bone loss and fractures.
Once doctors realized that there were serious trade-offs to long-term high-dose treatment with corticosteroids, they became much more discriminating. Nowadays, drugs like prednisone are mostly reserved for serious conditions such as Addison’s disease, Crohn’s disease, lupus and cancers such as leukemia and multiple myeloma.
Doctors also offer athletes and older patients with arthritis steroid injections into sore joints. There is a general belief that such “local” treatments avoid the problems of systemic side effects.
But a new review in the journal Radiology (online Oct. 15, 2019) highlights some unpleasant reactions to such injections. Among the most worrisome is that corticosteroids can accelerate the progression of osteoarthritis in that joint. Certain types of stress fractures also become more likely, along with bone loss and rapid joint destruction.
One of the unexpected consequences of corticosteroids in joints is the impact on cartilage. It turns out that these compounds harm chondrocytes, the cells that repair damaged joint tissue and regenerate new cartilage.
One reader may have experienced such a problem: “Steroid injections did more damage than any good. My first hip injection helped my pain for about a week. I went through three injections spread out over nine months. By my third injection, the joint was bone-on-bone.”
Another reader’s experience demonstrates that even local treatments can have effects throughout the body. “I recently had two cortisone injections at one time, hip and sacroiliac joint. I was immediately so anxious I was in agony. I am still having trouble sleeping after three weeks. My blood pressure shot up to 170 over 85 for a few days. My blood sugar levels were also unusually high. I lost 4 pounds in a week, although I was eating as usual. All in all, it was a horrible experience. And only one of the two injections relieved my pain. I will never have another cortisone injection.”
Insomnia, anxiety, hypertension and elevated blood sugar are well-recognized reactions to corticosteroids.
On the other hand, some people who have had such injections have been very pleased with the results. One woman remarked: “At around 60 years old, I’d have been unable to continue my daily 25-minute walk had I not had a knee injection. It did not hurt much. A few years later, I repeated it. Since then (I’m 71 now), I’ve not had any significant problems and have walked every day. I strengthen my knees at home with easy exercise and eat a very nutritious diet that keeps me thin.”
When patients are offered the possibility of relieving joint pain with a steroid injection, they need to be fully aware of the risks as well as the benefits.
King Features Syndicate