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Cortisone infiltrations are used in the conservative treatment of joint pathologies that recognize an inflammatory component, such as rheumatoid arthritis, psoriatic arthritis, gouty arthritis and acute arthrosic processes. Similarly, corticosteroids can be injected locally to treat tendinitis and bursitis.
Treatment characteristics
Based on the desired effect and the pathology that afflicts the patient, it is possible to choose the type of cortisone to be used: there are available corticosteroids with rapid action and short duration useful, in case of acute pathologies in which an immediate effect is desired, and corticosteroids with a slower but prolonged onset that are used instead in the case of chronic diseases. Whatever the chosen cortisone, the active ingredient is generally accompanied by a local anesthetic, typically lidocaine.
The therapeutic scheme varies according to the type of pathology and its severity: the standard approach foresees an infiltration per week for a variable number of times (from three to five), but by virtue of the possible side effects some doctors recommend not to exceed 3-4 infiltrations a year, separating them by at least a month.
The powerful anti-inflammatory and immunosuppressant effect of cortisone helps to provide relief from pain and joint effusions in the acute phase of the disease.
Side effects
Although only a small proportion of the injected drug reaches the systemic circulation, thus limiting the side effects of the classic cortisone therapies,
- even at the intra-articular level the abuse of these drugs can cause serious consequences.
Chronic Side Effects
An excessive number of cortisone infiltrations can weaken tendons, ligaments, bones and other structures that participate in the joint. Furthermore, the small proportion of the drug that enters the circulation can be important for some categories of patients.
Acute Side Effects
If carried out in compliance with the rules of asepsis (hair removal, thorough cleansing and disinfection of the skin, replacement of the needle after aspiration of the drug), cortisone infiltrations generally do not cause any relevant local effect. Among the most common side effects is the risk of an inflammatory reaction, with local pain and redness that tends to resolve within 24 hours, either spontaneously or with the aid of non-steroidal anti-inflammatory drugs. Cutaneous atrophy and depigmentation of the treated part represent the possible consequence of cortisone extravasation through the needle route into the surrounding skin.
Contraindications
Possible contraindications to cortisone infiltration:
- anti-thrombotic therapy with warfarin (Coumadin) or acenocumarol (Sintrom): risk of bleeding inside the joint
- competitive athletes: risk of positive anti-doping controls
- diabetes: increase in blood sugar after infiltration
- hypertension: increased pressure after infiltration
- immunodepression: increased risk of local infection
- severe osteoporosis: aggravation of osteoporosis of the treated joint
For this reason it is good to limit the use of cortisone infiltrations to the acute phases of arthropathy, when pain and inflammation are important and strongly limit joint mobility. Once this phase is over, it is preferable to resort to specific infiltrations of hyaluronic acid that have shown an analgesic efficacy similar to that of intra-articular cortisone injections. Furthermore, hyaluronic acid is a natural component of the joint and is free from the important side effects attributed to prolonged cortisone therapies. The infiltrations of sodium hyaluronate are preferable to those of cortisone especially in the case of arthrosis.
