Steroid Shot Side Effects: Steroid Injections are BAD NEWS
Traditional medicine has a secret addiction that’s hurting patients. Like the addict who just can’t stop, it needs a serious intervention. What are physicians addicted to? Steroids shots that are reimbursed by insurance but that are making patients worse. So let’s dive into steroid shot side effects and find out what all of the traditional medical sites will never tell you.
What are Steroid Shots?
Steroid shots are often used to treat joint pain due to arthritis or tendinopathy like tennis elbow or shoulder rotator cuff pain. They are composed of high doses of corticosteroid, which is similar to natural substances found in your body that reduce inflammation, but your body uses about one-millionth the dose. Hence the milligram dose of steroids injected by the doctor is massive compared to what your body is used to seeing, which is where the problems with these medications begin. These medications are anti-inflammatories and go by names like Depo-Medrol, betamethasone, dexamethasone, triamcinolone, methylprednisolone, Celestone, and Kenalog.
Steroid Shot Side Effects Chapter 1: Destroying Cartilage
Cartilage is that cushiony stuff on the ends of long bones that acts as a shock absorber for the joint. When arthritis sets in, the cartilage gets worn away causing a “bone on bone” situation. So anything that’s used to treat arthritis pain that causes cartilage to die-off is a bad therapy.
We’ve known for a LONG time that steroid shots destroy cartilage. In fact, the first paper on steroid shot side effects was in 1951! (7) That was followed by others in the 60s and then a parade of animal studies showing that steroid shots hurt cartilage cells in joints, (9,11) If there was any doubt left that steroids hurt joints, recently a randomized controlled trial in real patients with knee arthritis showed that patients who got steroid shots for knee arthritis not only showed no improvement over saline injections, but they also had an accelerated loss of cartilage (1).
Steroid Shot Side Effects Chapter 2: Increasing Risk of Infection or Joint Replacement
It’s hard to imagine that a simple steroid shot in a joint could increase your risk for a joint infection if you need a joint replacement, but this is a real thing. In addition, it’s equally hard to imagine that this shot could make you more likely to need a joint replacement if you have arthritis. Let’s dig into what we know.
We’ve also known for quite some time that patients who get steroid shots for various types of joint pain or arthritis are at higher risk for infection if they get a joint replacement at some point down the road (3). This is a thing not only for knees but also for hips as well (5). We also know that getting a steroid shot to help knee arthritis pain can increase the likelihood of needing a knee replacement, meaning the shot causes more knee cartilage breakdown (2). Hence, steroid shot side effects include increasing the risk for a joint replacement complication or for needing one in the first place.
How big a deal is an infected knee or hip replacement? Major. The average patient will need 6-12 weeks of IV antibiotics through a catheter inserted to a spot near the heart. For some patients, this won’t be enough to heal the infection and instead, they’ll have to have their infected joint ripped out and a new one implanted.
Steroid Shot Side Effects Chapter 3: Systemic Problems
While the local impacts of steroid shots are quite real and devastating, there are also impacts on the whole body. Why? The steroids injected into joints and tendons are at high enough dose that they leach into many parts of the body. Hence, steroid shot side effects can include problems with bone repair, the endocrine system, and blood sugar.
For example, one study demonstrated that steroids used in epidural injections for back pain worsened osteoporosis in women (4). The same type of steroid shots also mess with the cortisol endocrine system that helps to keep you healthy (6). Finally, getting your knee joint injected also messes with your blood sugar, causing it to increase (12),
Steroid Shot Side Effects Chapter 4: New Research
We’ve known for a while that steroid shot side effects include problems with shoulder rotator cuff healing. For example, in one study measuring the healing blood vessels that grow into shoulder rotator cuff tears, patients who had steroid shots had fewer new blood vessels (10). In another, tendon cells in patients getting steroid shots were injured by the medication (13). In a more recent large review, steroid shot side effects in patients undergoing rotator cuff repair included higher retear rates (when the rotator cuff surgery fails) as well as the need for another surgery (14).
The new research on knees is also not good for patients who get steroid shots. In this study, the authors looked at almost four thousand patients who were part of a government-funded arthritis study (15). Each steroid shot in the knee increased the likelihood of needing a knee replacement by 9%. Meaning if you got 4 steroid shots to help arthritis pain, this increased the likelihood that you needed a knee replacement by about 36%!
Chapter 5: Is There an Alternative that Won’t Fry My Joints?
Platelet-rich plasma (PRP) is a well-researched alternative to steroid shots without the crazy side effects. This is where the doctor takes blood from a vein and then concentrates the healing platelets and then reinjects that preparation. How much research do we have that PRP helps? Let’s take a look at just one common problem area, knee arthritis
We have almost 30 high-level studies to date on PRP used to treat arthritis. These studies have compared PRP to other common treatments like steroid shots, hyaluronic acid (HA) injections (aka knee gel shots), or physical therapy exercises (16-32). PRP was as effective as knee gel shots or better and worked better than steroid shots or exercise. We also have research that shows that PRP works well when compared to a placebo treatment like saline.
The upshot? Steroid shot side effects are very real. Please avoid these procedures! There are newer ways to help joint pain or torn up tendons that use your body’s own healing agents like PRP. We in traditional medicine need to stop our addiction to injecting these dangerous substances just because they’re covered by insurance.
(1) McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA.2017;317(19):1967–1975. doi: 10.1001/jama.2017.5283
(2) Wijn SRW, Rovers MM, van Tienen TG, Hannink G. Intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty. Bone Joint J. 2020 May;102-B(5):586-592. doi: 10.1302/0301-620X.
(3) Richardson SS, Schairer WW, Sculco TP, Sculco PK. Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am. 2019 Jan 16;101(2):112-118. doi: 10.2106/JBJS.18.00454.
(4) Kang SS, Hwang BM, Son H, Cheong IY, Lee SJ, Chung TY. Changes in bone mineral density in postmenopausal women treated with epidural steroid injections for lower back pain. Pain Physician. 2012 May-Jun;15(3):229-36.
(5) Ravi B, Escott BG, Wasserstein D, Croxford R, Hollands S, Paterson JM, Kreder HJ, Hawker GA. Intraarticular hip injection and early revision surgery following total hip arthroplasty: a retrospective cohort study. Arthritis Rheumatol. 2015 Jan;67(1):162-8. doi: 10.1002/art.38886.
(6) Chon JY, Moon HS. Salivary cortisol concentration changes after epidural steroid injection. Pain Physician. 2012 Nov-Dec;15(6):461-6.
(7) STEINBROCKER O, EHRLICH ME, SILVER M, SICHER W, BERKOWITZ S, CARP S, FEISTEIN H. The clinical application of cortisone and ACTH in arthritis and related conditions: methods and problems. II: Side effects complications, contraindications, precautions and conclusions. Ariz Med. 1951 Sep;8(9):29-35.
(8) Brånemark PI, Goldie I. Observations on the action of prednisolone tertiary buryl acetate (Codelcortone TBA) and methylprednisolone acetate (depomedrone) on normal soft tissues. Acta Rheumatol Scand. 1967;13(4):241-56.
(9) Wang BL, Sun W, Shi ZC, et al. Decreased proliferation of mesenchymal stem cells in corticosteroid-induced osteonecrosis of femoral head. Orthopedics. 2008;31(5):444. doi:10.3928/01477447-20080501-33
(10) Bonnevialle N, Bayle X, Projetti F, Wargny M, Gomez-Brouchet A, Mansat P. Variations of the micro-vascularization of the greater tuberosity in patients with rotator cuff tears. Int Orthop. 2015;39(2):371‐376. doi:10.1007/s00264-014-2628-z
(11) Murray RC, DeBowes RM, Gaughan EM, Zhu CF, Athanasiou KA. The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse. Osteoarthritis Cartilage. 1998;6(2):106‐114. doi:10.1053/joca.1997.0100
(12) Habib GS. Systemic effects of intra-articular corticosteroids. Clin Rheumatol. 2009;28(7):749‐756. doi:10.1007/s10067-009-1135-x
(13) Dean BJ, Franklin SL, Murphy RJ, Javaid MK, Carr AJ. Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy?. Br J Sports Med. 2014;48(22):1620‐1626. doi:10.1136/bjsports-2013-093178
(14) Cimino AM, Veazey GC, McMurtrie JT, et al. The Effect of Corticosteroid Injections on Clinical Outcomes and Failure Rates after Rotator Cuff Repair: A Systematic Review [published online ahead of print, 2020 May 7]. Arthroscopy. 2020;S0749-8063(20)30379-0. doi:10.1016/j.arthro.2020.04.044
(15) Wijn SRW, Rovers MM, van Tienen TG, Hannink G. Intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty. Bone Joint J. 2020;102-B(5):586‐592. doi:10.1302/0301-620X.102B5.BJJ-2019-1376.R1
(16) Uslu Güvendi E, Aşkin A, Güvendi G, Koçyiğit H. Comparison of Efficiency Between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients With Knee Osteoarthritis. Arch Rheumatol. 2017;33(3):273–281. Published 2017 Nov 2. doi: 10.5606/ArchRheumatol.2018.6608
(17) Tavassoli M, Janmohammadi N, Hosseini A, Khafri S, Esmaeilnejad-Ganji SM. Single- and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial. World J Orthop. 2019;10(9):310–326. Published 2019 Sep 18. doi: 10.5312/wjo.v10.i9.310
(18) Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, Navarro A. Platelet-Rich Plasma Injections for Advanced Knee Osteoarthritis: A Prospective, Randomized, Double-Blinded Clinical Trial. Orthop J Sports Med. 2017;5(2):2325967116689386. Published 2017 Feb 13. doi: 10.1177/2325967116689386
(19) Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord. 2015;8:1–8. Published 2015 Jan 7. doi: 10.4137/CMAMD.S17894
(20) Montañez-Heredia E, Irízar S, Huertas PJ, et al. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System. Int J Mol Sci. 2016;17(7):1064. Published 2016 Jul 2. doi: 10.3390/ijms17071064
(21) Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):958-965. doi: 10.1007/s00167-015-3705-6.
(22) Lana JF, Weglein A, Sampson SE, et al. Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med. 2016;12(2):69–78. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227106/
(23) Tavassoli M, Janmohammadi N, Hosseini A, Khafri S, Esmaeilnejad-Ganji SM. Single- and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial. World J Orthop. 2019;10(9):310–326. Published 2019 Sep 18. doi: 10.5312/wjo.v10.i9.310
(24) Lin KY, Yang CC, Hsu CJ, Yeh ML, Renn JH. Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial. Arthroscopy. 2019 Jan;35(1):106-117. doi: 10.1016/j.arthro.2018.06.035.
(25) Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis : A prospective randomized controlled study. Orthopade. 2019 Mar;48(3):239-247. doi: 10.1007/s00132-018-03659-5.
(26) Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, Kon E, Filardo G. Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial. Am J Sports Med. 2019 Feb;47(2):347-354. doi: 10.1177/0363546518814532.
(27) Yu W, Xu P, Huang G, Liu L. Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis. Exp Ther Med. 2018;16(3):2119–2125. doi: 10.3892/etm.2018.6412
(28) Buendía-López D, Medina-Quirós M, Fernández-Villacañas Marín MÁ. Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J Orthop Traumatol. 2018;19(1):3. Published 2018 Aug 20. doi: 10.1186/s10195-018-0501-3
(29) Su K, Bai Y, Wang J, Zhang H, Liu H, Ma S. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol. 2018 May;37(5):1341-1350. doi: 10.1007/s10067-018-3985-6.
(30) Louis ML, Magalon J, Jouve E, Bornet CE, Mattei JC, Chagnaud C, Rochwerger A, Veran J3, Sabatier F. Growth Factors Levels Determine Efficacy of Platelets Rich Plasma Injection in Knee Osteoarthritis: A Randomized Double Blind Noninferiority Trial Compared With Viscosupplementation. Arthroscopy. 2018 May;34(5):1530-1540.e2. doi: 10.1016/j.arthro.2017.11.035.
(31) Lisi C, Perotti C, Scudeller L, Sammarchi L, Dametti F, Musella V, Di Natali G. Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial. Clin Rehabil. 2018 Mar;32(3):330-339. doi: 10.1177/0269215517724193
(32) Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-346. doi: 10.1177/0363546516665809.