Injection therapy Patient Information

What is a corticosteroid joint injection?

A corticosteroid (or ‘cortisone’ or ‘steroid’) is an anti-inflammatory medicine, which can be injected directly into the tissues that are causing your symptoms. When your joints are swollen and tender the condition can be treated by putting a needle directly into your joints to draw out fluid and if required, we can inject a corticosteroid into them at the same time. This procedure is an alternative to taking anti-inflammatory medication by mouth. It acts directly in the area injected and is not the same as the steroids sometimes taken by bodybuilders. Joint injections are used to treat people with rheumatoid arthritis, osteoarthritis and many other conditions. Sometimes we also inject into the tissues around joints and tendons. You may also be given a local anaesthetic alongside the corticosteroid injection to numb the painful area of your body which is contributing to pain which can make the injection more comfortable.

How effective are corticosteroid injections?

Corticosteroid injections can be a rapid and effective treatment for joint pain and inflammation, although the improvement is usually temporary. Research tells us that, for joints with osteoarthritis, corticosteroid injections can produce an average of 6-12 weeks’ of pain relief. The corticosteroid injection should not be repeated more than three times a year on the same joint. It is recommended that you should not have regular injections as it can increase the risk of tendon rupture and hasten the process of degeneration in the joint. The effectiveness of the injection varies from person to person. In some cases, the injection does not work.

Will I feel any pain?

The injection is not particularly painful as the doctor or specialist musculoskeletal physiotherapist /First Contact Physiotherapist (FCP) is thoroughly trained in this procedure. Sometimes the site can be sore for a few hours after the procedure. It is safe for you to continue to take your prescribed pain relief or paracetamol if required following the injection.

Are there any treatment alternatives?

Alternatives to the injection include lifestyle changes, use of anti-inflammatory medicines and physiotherapy. Occasionally, obtaining a surgical opinion may be helpful. If you would like further information about these other options then please let us know and we can discuss this during the consultation in the GP surgery.

Is there any situation when I should not have an injection?

You should not have an injection if you:

→ have an infection or are taking antibiotics

• → are feeling unwell
• → are allergic to local anaesthetic or corticosteroids
• → are due to have surgery to the area soon intended for injection
• → are pregnant or breastfeeding
• → are under 18 years old
• → have poorly controlled diabetes
• → do not want the injection

Are corticosteroid injections safe?

Injection therapy is considered very safe. Single use, sterile, disposable needles are used in the clinic to administer the medication.

Are there any side effects or risks?

Possible side effects or risks do not happen very often and can include the following:

• → The injection may not work, or/and its effect may wear off.
• → Soreness following injection can occur for up to 48 hours – 72 hours. See ‘Will I feel any pain’ section above.

• → Allergic reaction to the medication in the injection is very rare and serous reactions usually

happen immediately so you will be asked to sit in the clinic for 20 minutes following your  injection to check for any reactions. If you have any signs of an allergic reaction after you have left the clinic, then please seek immediate medical advice.

• → Infection after injection is very rare but if the injection site becomes hot, red, swollen and/or painful, you must seek immediate medical review by visiting A&E.

• → Facial flushing happens in 1 in 20 people and can last for up to two days with no long-term effects.

• → In people with diabetes, corticosteroid injections can result in a slightly raised blood sugar level. If levels remain raised, you should seek further help from your GP or diabetes specialist nurse.

• → Bleeding/bruising around the area. This is more common if people are taking tablets which thin the blood (anti-coagulants) including warfarin or aspirin. Please advise the FCP if you are taking any blood thinning medicines during your consultation.

• → There is a slight possibility of a small dimple (fat atrophy) or skin colour change (depigmentation) in the skin around the injection site. This is harmless and only cosmetic in nature.

• → Disturbance with periods or a missed period can happen in some women.
• → Injury to nerves with certain types of injections is a rare complication which will be explained during the consultation if applicable to your procedure.

• → If the corticosteroid injection does not work, you cannot have surgery on that joint for six months.

Please refer to the manufacturer’s Patient Information Leaflet provided to you for more  details on side effects.  What happens during the injection procedure?

The benefits and risks of the injection will be explained to you in detail. You will then be placed in a comfortable position and the skin around the area to be injected is cleaned with antiseptic. A needle is gently positioned into the affected area and the solution is injected through the needle. A plaster will be placed over the injection site to keep it clean. A few minutes after the injection you may be examined again to check the joint movement.

Do I need to do anything after my injection?

• → Rest after the injection for up to 48 hours is advised. This means refraining from activities that make your pain worse for up to 48 hours, after which you should try gradually to return to full function.

• → Avoid any high impact exercises or activities for two weeks. This helps to reduce the small risk of tendon injury and maximise the benefits given by the injection.

• → Check for signs of infection such as severe pain, hot joint, redness, swelling at the injection site, in addition to feeling unwell. If you experience any of these symptoms seek urgent medical help.

If you are unsure, please contact your GP surgery.

• → Please talk to your doctor if you have any mental health concerns or feel persistently low in mood following the injection.

• → Please continue to take normal pain relief medication if you think you require this following your injection.

If you have any questions or concerns, please speak to the First Contact Specialist Physiotherapist who offered you injection by calling your GP surgery.

Further information

This information leaflet does not list all of the uses and side effects of the medicines we use – please see the manufacturer’s Patient Information Leaflet provided for further information. We welcome any suggestions about the quality of service you have received. This will help us to improve our service. If you wish to provide any feedback, please contact the GP surgery where you received your injection.

Coronavirus (COVID-19) and corticosteroid injections

You may be concerned about coronavirus in relation to corticosteroid injections. We are still learning about this new disease and the way it affects patients who are given some of our drugs. At the moment there is limited information about the use of corticosteroid injections during the coronavirus pandemic.

Possible effects of corticosteroid injection and COVID-19 infection

There is a theoretical risk of a corticosteroid injection making a patient more vulnerable to: getting COVID- 19; having it longer; and experiencing increased complications. ‘Theoretical’ means that the risks are possibilities but have not been scientifically proven. Therefore, we will only use corticosteroid injections as a treatment option when considered absolutely necessary by your clinician and when other safer options have been tried. We understand that you may be in considerable pain and discomfort. If this should be the case, the potential benefits of a corticosteroid injection may outweigh the potential risks. If you are at higher risk than others of being infected with COVID-19 we may suggest delaying the procedure or taking extra precautions, such as self-isolation, on a case-by-case basis.

Possible effects of corticosteroids on COVID-19 vaccine

There is also a theoretical risk that corticosteroids may reduce the immune response that is stimulated by a vaccine, so the level of protection you get from a vaccination may be reduced. We advise that you not to have a corticosteroid injection on the same day as a dose of a COVID-19 vaccine. You should also avoid having a corticosteroid injection for at least 2 weeks after a dose of the COVID-19 vaccine.

If you are planning on having a COVID-19 vaccine, we advise not to delay being vaccinated while you are waiting for a corticosteroid injection. When you are booking an appointment, please tell the staff if you are planning to have, or have already had, a COVID-19 vaccine. We will schedule the corticosteroid injection to accommodate your vaccine date if necessary.

Checklist: Corticosteroid injection and coronavirus

There is a checklist attached to this leaflet which should be completed prior to your appointment, which will help us to assess the risk. Any risk factors will be reviewed by the clinician performing the injection who will check that it is safe to proceed with it. After this you may be advised to self-isolate before and/or after the injection if you have other medical conditions.

You should also not attend your appointment if you develop or experience a high fever (temperature higher than 37.8C), a persistent cough, or loss of taste or smell. You should also not attend if you have had recent close contact with a known positive case of coronavirus. If you are worried about having your corticosteroid injection during the pandemic, please contact the healthcare professional who referred you for the injection. They can discuss the risks and benefits of the injection in more detail and consider options for a new referral once this period is over if you are happy to proceed.