The People's Perspective on Medicine

The Dark Side of Cortisone Shots: Joint Deterioration

When your knees, hips or shoulders hurt, you want rapid relief. Cortisone shots seem like a simple and fast solution. Are there risks with steroids shots?
Close-up Of A Cosmetologist Wearing Blue Surgical Gloves Makes Rejuvenation Beauty Injection On Woman’s Knee

You have no doubt heard about “steroids.” By the way, this is a terrible term! It causes nothing but confusion. We promise not to overwhelm you with chemistry. The core structure of steroids can be found in hormones like estrogen, progesterone and testosterone as well as in corticosteroids like cortisone and prednisone. The steroid injections we are referring have nothing to do with body building. This is all about cortisone shots for joint pain and inflammation.

corticosteroid chemical structure molecular diagram

Structural chemical formulas of corticosteroids (glucocorticoids): cortisol, cortisone, corticosterone

A Quick Overview of Cortisone:

A patient with rheumatoid arthritis first received cortisone just over 70 years ago. The results were impressive enough that doctors quickly embraced cortisone as a treatment for this crippling disease. By the early 1950s, patients were taking cortisone orally and receiving cortisone shots in their joints (Clinical and Experimental Rheumatology, Sept-Oct. 2011). 

Cortisone was hailed as a miracle cure for rheumatoid arthritis. It reduced the pain and inflammation that crippled many patients.

People who relied upon crutches or wheelchairs to move could suddenly get around on their own. Doctors who prescribed oral cortisone or administered cortisone shots were seen as heroes by patients in pain.

The Darker Side of Corticosteroids Emerges:

Before long, however, the dark side of corticosteroids began to appear. Patients taking high doses for long periods of time experienced side effects such as hypertension, heart failure, diabetes, loss of potassium, blood clots, weight gain, cataracts, glaucoma, muscle weakness, bone loss and fractures.

A close family friend ended up with severe osteoporosis and horrible fractures after taking high-dose cortisone for many years. 

Once doctors realized that there were serious tradeoffs to long-term, high-dose treatment with corticosteroids, they became 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.

When people experience severe asthma attacks or life-threatening allergic reactions, they may get cortisone shots in an emergency department. We have no quarrel with such treatments.

You can read about my personal story with prednisone. This corticosteroid reversed my sudden deafness (idiopathic sudden sensorineural hearing loss). Here is a link:

Prednisone Side Effects: Deal With The Devil?

Cortisone Shots: A Risky Tradeoff?

Doctors often offer athletes and older patients with arthritis steroid injections into sore joints. There is a widespread belief that such cortisone shots can provide “localized” treatment.

Many people, including some health professionals, believe that the injection of a corticosteroid such as methylprednisolone, betamethasone or triamcinolone into a joint can ease symptoms without systemic (whole body) side effects. There is growing awareness that conception may be way too optimistic.

Cortisone Shots and Joint Deterioration:

A review in the journal Radiology (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. In addition, if the bone tissue has begun to die (osteonecrosis), the steroid injection can make that worse. Certain types of stress fractures also become more likely, along with bone loss and rapid joint destruction.

Benefitting from Cortisone Shots:

Some people who have had such injections have been very pleased with the results.

One reader 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.”

Lizzie reports benefit from cortisone shots:

“I had three instances of corticosteroid injection in a hip joint for severe bursitis. It didn’t hurt. It helped. Bursitis cleared up with no relapse in the past thirty years. No arthritis or joint problems in hips again. So far!”

A Darker Side of Cortisone Shots:

Others have not had such good results.

According to another reader:

“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 shot.”

This reader’s experience demonstrates that even local treatments can have effects throughout the body. Insomnia, anxiety, hypertension and elevated blood sugar are well recognized systemic reactions to corticosteroids.

Taylor has seemingly experienced rapid knee deterioration from steroid injections:

“I am only 30 but I have already had eight knee surgeries. I used to get cortisone shots to get through a season. They worked great. I didn’t think there were any problems getting the injections every year. My doctors administered them willingly.

“I now have extremely bad arthritis. I am waiting to get a total knee replacement. The trick is finding a doctor who will perform this surgery on someone my age. It is interesting to think that those many years of cortisone shots might have actually made my knee problems get worse faster.”

Rose has a somewhat similar story:

“I have had a cortisone injection in both my knees every 3-4 months for the past four years. Now I have bone on bone osteoarthritis in both knees.

“When I would ask my doctor if there was any danger from the cortisone shots he would always say no. He said that I could continue to get them every three months. My last shot in my left knee was three weeks ago. I got no relief at all.

“I am finally going to bite the bullet and have a total knee replacement. I fear that when they cut me open my joints and leg bones may not be strong enough to hold the replacement.”

Balancing Benefits and Risks of Cortisone Shots:

As you can tell, some people benefit from corticosteroid injections. This seems to be especially true if there is localized inflammation such as bursitis. If the cortisone shots are not administered too often, it is conceivable that lasting damage can be prevented.

On the other hand, the evidence is mounting that frequent injections can lead to joint damage. You can read much more about the actual mechanism whereby this happens at this link:

Corticosteroid Injections in Joints Accelerate Arthritis

Learn a lot more about other ways to deal with arthritis in our eGuide to Alternatives for Arthritis. This online resource is available at this link.

Share your own experience with cortisone shots in the comment section below. We would love to hear both sides of this controversial subject.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Alternatives for Arthritis
$4.99

This eGuide describes nondrug alternatives for arthritis with the latest scientific studies to document anti-inflammatory activity. This comprehensive online guide (too long to print) adds the science behind ancient healing traditions.

Alternatives for Arthritis
Citations
  • Benedek, T. G. “History of the Development of Corticosteroid Therapy,” Clinical and Experimental Rheumatology, Sept-Oct. 2011, PMID: 22018177
  • Kompel AJ et al, "Intra-articular corticosteroid injections in the hip and knee: Perhaps not as safe as we thought?" Radiology, Oct. 15, 2019. https://doi.org/10.1148/radiol.2019190341
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I am 62. My mother was a LPN for several years when I was younger. She told me 2 things about my knees: Don’t ever let a doctor cut them open (operate on) and NEVER get a cortisone injection. My knees aren’t the greatest but I can manage well enough to avoid those 2 things!

Ask yourself do the benefits outweigh the risks. It’s up to you. With the computer age, you can decide for yourself.

What I don’t see mentioned is the fact that some (all?) insurance companies require one or more cortisone injections before they’ll pay for other treatments such as joint replacement. The patient has NO CHOICE but to get the injections as the first treatment option. I find this unconscionable.

I opted for Cortisone injections in both wrists to deal with carpal tunnel syndrome pain. The relief was significant for several months. When the pain became unbearable approximately one year later, I opted for another injection in the left wrist. This time, there was no relief from the pain. When consulting later with a hand surgeon, he pointed out the visible deterioration in my left wrist from the previous injections. He told me to never repeat Cortisone injections.

I was helped with several cortisone spinal injections, but eventually developed a-fib after one. It turned out to be a reaction with epinephrine which was mixed in with the cortisone. I avoid taking “epi” now for any reason.
Nan B.

Back pain 24/7 for over 15 years….so I’ve tried everything. The shots did absolutely NOTHING for my pain. Injections were done by 3 different doctors over a period of 3/4 years. NOTHING.
Have taken every pain med on the market.. NOTHING.
Am taking hemp CBS and that has helped but it does not last long.
Am taking Kratom and that has helped but it does not last long.
Guess what?….I have accepted that I will be working through the pain….

I’ve had injections in both hips every 3 months for the last 5 years with great relief. I’m getting both hips replaced next year, which was inevitable. So my question is, if they’re going to remove the arthritic parts of the bone anyway, should I really be worried about osteonecrosis?

After reading about side effects I was going to ask if they are temporary or permanent; however, it appears they are permanent. So why would any physician give you meds that would give you another disease? It seems they are putting a band-aid on symptoms and not the root of the problem. We have some wonderful advances in medicine but if our forefathers could do brain surgery back then why do we think we are so advanced today. We are missing something, and it is not a pill for this and a pill for that.

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