From the FDA Drug Label
Frequent intra-articular injection may result in damage to joint tissues. A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise is suggestive of septic arthritis Patients should be impressed strongly with the importance of not overusing joints in which symptomatic benefit has been obtained as long as the inflammatory process remains active.
Dexamethasone may cause knee pain due to joint tissue damage from frequent intra-articular injections or septic arthritis if the injection is given into an infected site. It is essential to follow proper administration guidelines and monitor patients for signs of infection or joint damage 1, 1. Key considerations include:
- Avoiding injection into unstable or infected joints
- Not overusing joints with symptomatic benefit
- Monitoring for increased pain, swelling, or restricted joint motion
- Seeking medical advice if exposed to certain infections while on immunosuppressant doses of corticosteroids.
From the Research
Dexamethasone is unlikely to cause knee pain as a direct effect, but its long-term use can lead to joint problems, including knee pain, due to osteoporosis and avascular necrosis. Dexamethasone is a potent corticosteroid that is typically used to reduce inflammation and suppress immune responses in various conditions. While it often relieves joint pain when used for inflammatory conditions, prolonged use of dexamethasone can paradoxically lead to joint problems, including knee pain. This occurs primarily through two mechanisms: first, long-term corticosteroid use can cause osteoporosis and weaken the bones around joints; second, it may lead to avascular necrosis (death of bone tissue due to interrupted blood supply), particularly in weight-bearing joints like the knees and hips. Some studies have investigated the effects of dexamethasone on knee pain and osteoarthritis, including a 2024 study 2 that found no prolonged effects of dexamethasone on overall pain or sleep quality after total knee arthroplasty. Another study from 2014 3 found that dexamethasone inhibited inflammation and cartilage damage in a post-traumatic osteoarthritis model. However, the most recent and highest-quality study, published in 2024 2, suggests that dexamethasone does not have a significant impact on knee pain after total knee arthroplasty. Key points to consider:
- Dexamethasone can relieve joint pain in inflammatory conditions
- Long-term use can lead to osteoporosis and avascular necrosis, potentially causing knee pain
- Recent studies have shown mixed results regarding the effects of dexamethasone on knee pain and osteoarthritis
- The most recent and highest-quality study found no prolonged effects of dexamethasone on overall pain or sleep quality after total knee arthroplasty. If you're experiencing knee pain while taking dexamethasone, it's essential to discuss this with your healthcare provider rather than discontinuing the medication abruptly, as sudden stoppage can cause serious withdrawal symptoms. Your doctor might need to adjust your dosage, provide supplementary treatments for bone health, or consider alternative medications depending on your specific condition.