How long before I can have another steroid / cortisone injection?
You may have had a steroid injection to alleviate the symptoms of arthritis, joint pain, soft tissue inflammation or tendon sheath inflammation like tenosynovitis. If you found it useful then you may be thinking “how long will a steroid injection last?” (You can read more about this on our post here) Or “when can I have another steroid injection?”.
What is a steroid injection used for?
A steroid injection, for the most part, is to relieve symptoms of inflammation to allow you a window in which to rehabilitate. In most cases, just one injection will be enough. In some cases, the steroid injection will be curative. In other cases you get relief, but some symptoms may be returning after a period of time and you may benefit from another injection.
How long to wait for another steroid injection can vary
f you are suffering from an inflammatory arthritis, then we may be more inclined to settle the inflammation as quickly as possible to give you relief and repeat an injection after a few weeks. In other cases, we may ask you to postpone a follow up injection to ensure we do not cause any detrimental effects to the surrounding tissues.
The National Institute for Care and Excellence (NICE) guidelines recommend no more than 4 steroid injections into any 1 joint per year. With this in mind, we tend to allow at least 3 months between injections. A double blind placebo controlled study of repeated steroid injections for knee arthritis by Raynauld et al in 2003 showed that over a 2 year period, a steroid injection every 3 months vs a placebo saline injection, had no detrimental effect on the cartilage in the joint on imaging and symptomatically, patients responded better with less pain.
However, if you are in pain and want to repeat an injection sooner we would usually recommend waiting 6 weeks before having another steroid injection.
Should I get another steroid injection?
A steroid injection can take up to 2 weeks to take effect. It can last anywhere between 6 weeks to 6 months. The majority of evidence for knee joint arthritis suggests benefits are unlikely to last beyond 3 months (Orchard, 2020.) but it is important to remember that the injection should be used alongside other interventions like exercise, diet and activity modification.
To minimise causing side effects, we wouldn’t usually inject again within a few weeks of having the first injection as it will still be present locally and having an effect if administered correctly. Unfortunately everyone will respond differently to a steroid injection so there are no hard and fast rules and if you didn’t get relief the first time, then perhaps repeating the injection may not help either. If you are not in pain, then there is no reason to repeat the injection.
What are my options?
If you think you may need a follow up injection, then consider when the last injection was and get in touch if you are unsure or have further questions. If you are within 6 weeks, then give it a little more time and keep working on your rehabilitation in the mean time.
There are alternatives to steroid injections if repeating is not optimal for you. Hyaluronic acid has been shown to give relief in mild to moderate arthritic joints like the knee. These injections can last longer and usually are well tolerated as they are not a drug but a joint lubricant that is already present in the body. You can read more about these injections here:
Summary
In summary you may experience a benefit from a steroid injection, and these can be repeated safely. Everyone is different and unfortunately things can be unpredictable, so if it didn’t help the first time, we need to ensure it was the right dose, in the right location and accompanied by the right rehabilitation. If a repeat steroid injection would be beneficial for you, then we can help decide when the best time to do this is.
References:
Orchard J W. Is there a place for intra-articular corticosteroid injections in the treatment of knee osteoarthritis? BMJ 2020; 368 :l6923 doi:10.1136/bmj.l6923
Raynauld, J.-P., Buckland-Wright, C., Ward, R., Choquette, D., Haraoui, B., Martel-Pelletier, J., Uthman, I., Khy, V., Tremblay, J.-L., Bertrand, C. and Pelletier, J.-P. (2003), Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: A randomized, double-blind, placebo-controlled trial. Arthritis & Rheumatism, 48: 370-377. https://doi.org/10.1002/art.10777
If you would like more information or would like to book an appointment, please contact us on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk