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Steroid Joint Injections - Friend or Foe?


By Jessica Kelner, D.O. - April 24, 2019

What are "steroids"? 

When you are talking about joint pain or an upper respiratory infection and you hear someone say they were treated with "steroids", this means they were given a drug that stoped the body's immune system from reacting to their injury or illness.  

"Steroid" or cortisone injections have been used by the traditional medicine world for a long time to help relieve pain that people have from "arthritis".  These steroid shots are not solving the problem, but simply just putting a bandaid on the issue.  The steroids may help temporarily, but a few weeks later, the pain will be back.  There are many patients that end up with a multitude of steroid injections for the same issue and subsequently, end up with pain that seems to get worse over time.  Even their injury can get worse.  They may loose more cartilage and be in worse shape.  What many don't realize is their joint is actually deteriorating at a faster pace because of these injections. 
 

What Steroid Injections Really Do:

Most  people have heard about steroid injections, but have never heard about Platelet Rich Plasma (PRP) or prolotherapy as an alternative to treat many of the same issues.  It has been known for a long time that steroids are damaging on the body, but patients often agree to these injections with hopes that the steroid injection will benefit them more than it will harm them.  Maybe people aren't aware  of how bad these injections really are for you?  If patients were only told about the long term side effects and the alternative options out there, would they still choose to have the steroid injection?

Cartilage and Bone Loss
Traditionally, in medicine doctors may continue to use a drug or perform a surgery that doesn't have great odds at resolving an issue until there is enough evidence to say that it is not helping, but may be even harming the patient.  When it comes to steroids for joint injections, there have been countless studies  reporting that steroids cause cartilage loss and do not provide a significant difference in pain relief when compared to saline (salt water). 

Doctors are injecting steroids into tendons for their "anti- inflammatory" properties.  However, research has shown us that  steroids can actually impair tendon healing and lead to tendon rupture.   It is also well known that long term steroid use, either by mouth or injection causes bone loss and bone necrosis, therefore putting the patient at a higher risk for bone fractures.   

Damage Stem Cells 
The body has an incredibly ability to repair itself.  When you're in pain from an injury, that is your body's way of telling you not to use the area and allow it to heal itself.  If you go to a traditional doctor with shoulder pain for example, they may offer you a steroid injection, while this may help you in the short term, studies have shown that not only do steroids damage the cartilage that protects the bones, but steroids also  impair your natural stem cells that are trying to heal your body.  Stem cells are pre-cursor cells that are able to help you regrow new tissue. Even as adults, we do have some stem cells that can help re-build and repair. 

Adrenal Insufficiency 
Steroids are esentially artificial cortisol. Cortisol is the body's natural stress hormone made in the adrenal glands that your body needs to function. Cortisol is produced in high amounts with stress and it naturally suppresses your immune system to get through the challenging time. If you give the body artificial cortisol, this will suppress the body's own natural cortisol production and have long term consequences.  A study looked at patients that had either received steroid knee injections or hyaluronic acid knee injections.  60% of the steroid knee injection participants end up with secondary adrenal insufficiency vs 15% of the hyaluronic acid group. 

 

What Regenerative Medicine Injections Do:

Regenerative Medicine injections like Platelet Rich Plasma (PRP) or Prolotherapy are essentially the polar opposite of steroids. They harness your body's natural immune system and repair mechanisms by recruiting them to come heal the area.  When you cut yourself, do you notice how you stop bleeding in a minute or so and eventually the cut will heal and be sealed up? It is your body's platelets that start that repair process. They are the first to the scene when you have a new injury. They bring with them a patch for the repair and an army of signaling molecules to tell your body what is needed to get the job done.  Platelet Rich Plasma is a type of prolotherapy ("prolo" means to proliferate or regrow) treatment where  platelets are isolated from your blood and then injected back into the injured area. PRP and prolotherapy can be used to treat many conditions like muscle, ligament,  tendon injuries, arthritis, and much more.  

There have been many studies published more recently showing that PRP has long lasting healing benefits, while steroids may help in the short term, they do not provide a long term benefit to the patient.  So, the next time you have an issue and are offered a steroid injection, consider regenerative medicine instead.  While steroids may be covered by insurance and Regenerative Medicine may not be, the damage from steroids may be detrimental and cause you more pain in the long run.  The short term out of pocket cost will give you a long term benefit and pain relief.