From the Guidelines
Cortisone injections typically begin working within 2-4 weeks, providing short-term relief for patients with knee osteoarthritis. The effects of cortisone injections can vary significantly between individuals, and the duration of pain relief can last from several weeks to a few months 1. According to the most recent guidelines, intra-articular injections of corticosteroids are recommended for patients with persistent pain after first-line treatments and oral NSAIDs, suggesting that this approach is more effective in those with more severe pain 1.
Key Points to Consider
- The full anti-inflammatory effects of cortisone injections usually develop over a short period, providing relief for patients with knee osteoarthritis 1.
- The presence of effusion is not a recommended predictor of a positive response to intra-articular corticosteroids, according to the latest guidelines 1.
- Intra-articular hyaluronic acid (IAHA) is also recommended in patients with knee OA, particularly those with contraindications to NSAIDs or those who are still symptomatic despite use of NSAIDs 1.
- Patients should be aware that they might experience a temporary increase in pain for 24-48 hours after injection, known as "post-injection flare," which can be managed with ice application and over-the-counter pain relievers.
Factors Influencing Effectiveness
- The injection site, severity of the condition, and individual patient factors all influence how quickly and effectively the medication works.
- The type of corticosteroid used, such as short-acting or longer-acting formulations, can also impact the duration of pain relief 1.
Recommendation
Based on the most recent and highest quality study, cortisone injections are recommended for patients with knee osteoarthritis who have not responded to first-line treatments and oral NSAIDs, with the expectation of short-term relief 1.
From the Research
Time Cortisone Injections Take to Work
- The time it takes for cortisone injections to work can vary depending on the specific condition being treated and the individual patient's response to the treatment 2, 3.
- In a study on the use of triamcinolone acetonide extended-release for osteoarthritis of the knee, patients received a second injection timed to their response to the first injection, with a median time to second injection of 16.6 weeks 2.
- Another study on the use of ultrasound-guided intra-articular triamcinolone acetonide injection for refractory small joints arthritis in rheumatoid arthritis patients found that pain and tenderness scores showed gradual improvement at 24 hours, 1 week, 4 weeks, and 12 weeks after treatment 3.
- A comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in the treatment of juvenile rheumatoid arthritis found that the mean time to relapse was 10.14 months for triamcinolone hexacetonide and 7.75 months for triamcinolone acetonide 4.
Factors Affecting Response Time
- The response time to cortisone injections can be influenced by factors such as the dose and type of corticosteroid used, the severity of the condition being treated, and the individual patient's response to the treatment 2, 3, 4.
- The use of hyaluronic acid conjugates with triamcinolone acetonide has been shown to enhance the targeting ability of the drug to inflamed tissue and reduce the risk of osteoporosis 5.
Clinical Implications
- The time it takes for cortisone injections to work can have important implications for clinical practice, including the timing of follow-up appointments and the need for additional treatments 2, 3.
- The choice of corticosteroid and the dose used can also impact the response time and the overall effectiveness of the treatment 4.