Can oral steroids, such as prednisone (corticosteroid), be used to treat knee bursitis?

Oral Steroids for Knee Bursitis

Oral steroids are not recommended as first-line treatment for knee bursitis; instead, intra-articular corticosteroid injections are preferred for short-term pain relief when conservative measures fail.

Treatment Algorithm for Knee Bursitis

First-Line Management

1. Conservative Measures

   • Rest and activity modification to reduce joint stress 1
   • Ice application to reduce inflammation
   • NSAIDs (oral or topical) for pain and inflammation 2, 1
     • Naproxen 500mg twice daily for 4-6 weeks 1
     • For patients ≥60 years or with GI risk factors: use topical NSAIDs, acetaminophen, or add gastroprotective agents 2

2. Physical Therapy

   • Quadriceps strengthening exercises 1
   • Range of motion exercises 1

Second-Line Management

1. Intra-articular Corticosteroid Injection

   • Provides significant short-term pain relief (1-4 weeks) 2, 1
   • More effective than oral steroids for localized inflammation 2
   • Ultrasound-guided injection preferred (95.5% accuracy vs 77.2% for blind injection) 1
   • Limit frequency to no more than 3-4 injections per year 1

2. Aspiration

   • For large effusions causing pain and limited mobility 3
   • Should be performed before corticosteroid injection if significant effusion is present

When to Consider Oral Steroids

Oral steroids are generally not mentioned in major guidelines for knee bursitis treatment 2, 1. Instead, the guidelines strongly recommend:

• Local treatments (intra-articular injections) for better targeted therapy with fewer systemic side effects 2, 1
• NSAIDs for systemic anti-inflammatory effects when needed 2, 1

The only scenario where oral steroids might be considered is in cases of widespread inflammatory conditions affecting multiple joints, such as rheumatoid arthritis with associated bursitis 4, but this is not specific to isolated knee bursitis.

Alternative Treatments for Persistent Cases

1. Hyaluronic Acid Injections

   • May provide longer-lasting relief than corticosteroid injections for persistent cases 1
   • Particularly effective in early radiographic stages of osteoarthritis with bursitis 1

2. Other Injection Options

   • Oxygen-ozone or prolotherapy injections may provide longer-lasting effects than corticosteroids in some cases of pes anserine bursitis 5

3. Surgical Intervention

   • Reserved for recalcitrant bursitis that fails to respond to conservative and injection therapies 3

Important Considerations and Cautions

• Infection Risk: Always rule out septic bursitis before administering corticosteroids; oral antibiotics are required if infection is present 3
• Monitoring: Assess response to treatment at 2-4 weeks 1
• Referral Indications: Persistent effusion despite 4-6 weeks of conservative management requires specialist referral 1
• Diagnostic Accuracy: Ensure accurate diagnosis through proper clinical examination and imaging when necessary 1

Conclusion

For knee bursitis, the evidence strongly supports a treatment approach that begins with conservative measures and progresses to targeted intra-articular corticosteroid injections rather than oral steroids. This approach maximizes therapeutic benefit while minimizing systemic side effects.