I’ve blogged quite a bit on the inconvenient truth that while steroid medications are powerful anti-inflammatories that are commonly used without much medical thought, they’re really bad for your body. As one example, a prior highlighted study had shown that getting a hip steroid shot increases the likelihood that a hip replacement surgery will fail and/or the patient will get a nasty post-op infection. Now a new study found joint replacement infection to be one of the side effects of steroids prescribed orally as well.
Steroids in the Water Supply
I see it every day in clinical practice: doctors use high-dose steroids like they’re sprinkling holy water. Got back pain? Let’s get you some steroid pills. How about a sore knee or hip? Let’s inject some steroids. In fact, I just spoke to a patient on Tuesday of this week about the fact that a local physician had injected his hip with steroids. He really had no idea that this choice not only endangered the joint through additional damage caused by the medications but also increased his risk for a hip replacement failure or infection. So before we move on to the new study, let’s review a few prior posts on the side effects of steroids and just how bad steroids can be for you:
- A hip steroid shot given during the year prior to hip replacement surgery increases the risk for surgical infection by 37% and risk of a second hip replacement surgery (within two years of the first replacement) by 53%.
- Steroids, in the usual doses, kill mesenchymal stem cells (the most common stem cells used to treat orthopedic conditions).
- Taking oral steroids increases the risk of osteonecrosis of the hip.
- Steroid shots may provide short-term relief, but they inhibit healing, and pain will return with more severity.
- For up to three weeks following a steroid injection, the steroid suppresses your response to stress by negatively affecting your hypothalamus-pituitary-adrenal axis (HPA axis)—the stress-management hormones.
- Epidural steroid injections increase the risk of spinal fractures by 29% with each shot.
The New Study: Side Effects of Steroids Used Orally
The new research looked at the insurance claims of more than two thousand knee, hip, and shoulder joint replacement patients in the U.S. They then also examined if certain medications had any impact on whether a postoperative joint infection was reported. Not surprisingly, patients who were on oral-steroid medications were about 60% more likely to get an infected joint. Medications for gout were also a culprit (allopurinol).
Why does this happen? It’s pretty simple. Steroids work by powerfully suppressing inflammation. While we all think of inflammation as a bad guy, it’s also how we heal and fight infection. So any drug that suppresses inflammation will increase the likelihood of an infection. Given that a joint replacement infection is nasty, where the patient must be on IV antibiotics and often has to have the artificial joint removed and replaced, it’s amazing that more physicians haven’t gotten the memo on steroids.
The upshot? The side effects of steroids are nasty. However, if you have joint pain, you’ll get offered steroid shots or pills—it’s almost a given. Given that it likely will hurt your chances of responding to a stem cell procedure or, at the least, increase the likelihood of a post-op infection, if you need a joint replacement, “just say no” to drugs!