What conditions can steroid shots help with?

What Steroid Shots Can Help With

Steroid injections are effective for short-term pain relief (typically 1-4 weeks) in inflammatory joint conditions, acute flares of osteoarthritis especially with effusion, tendinopathies in the acute phase, bursitis, and sacroiliac joint pain, but should be used judiciously given their limited duration of benefit and potential adverse effects on cartilage with repeated use.

Primary Indications for Steroid Injections

Joint Conditions

Intra-articular corticosteroid injections are strongly recommended for knee and hip osteoarthritis, particularly during acute flares with joint effusion 1. The evidence demonstrates:

• Short-term efficacy (1-4 weeks) with pain relief effect size of 1.27 compared to placebo over 7 days 1
• Significant pain and functional improvement at 1 and 4 weeks, but no difference at 12 and 24 weeks 1
• Better outcomes in patients with effusion present, though one study suggests injections should not be reserved only for those with effusion 1

For rheumatoid arthritis, steroid injections are indicated as adjunctive therapy for acute episodes or exacerbations when one or two joints resist systemic therapy 2, 3.

Hand osteoarthritis receives a conditional recommendation for intra-articular corticosteroids, though evidence is less robust for this location 1.

Soft Tissue Conditions

Acute bursitis and tenosynovitis respond well to steroid injections 2. However, for chronic tendinopathies:

• Injected corticosteroids may provide more effective acute phase pain relief than oral NSAIDs 1
• They do not alter long-term outcomes and should be used with caution 1
• Injection into tendon substance may cause deleterious effects, potentially reducing tensile strength and predisposing to spontaneous rupture 1
• Peritendinous injections have unknown effects but warrant caution as they may inhibit healing 1

Spinal Conditions

Sacroiliac joint pain shows moderate evidence for short-term effectiveness when diagnosed with dual anesthetic blocks (>70-80% pain relief threshold) 1. Success rates are approximately 54.5% at 2-4 weeks when diagnosis is confirmed 1.

For chronic low-back pain without radiculopathy, epidural steroid injections are NOT recommended as long-lasting benefit has not been demonstrated 1.

Systemic Conditions (Intramuscular Administration)

When oral therapy is not feasible, intramuscular steroid injections are indicated for 2:

• Severe or incapacitating allergic conditions (asthma, atopic dermatitis, allergic rhinitis)
• Acute exacerbations of multiple sclerosis
• Severe dermatologic diseases (pemphigus, Stevens-Johnson syndrome)
• Selected hematologic disorders (autoimmune hemolytic anemia)
• Acute gouty arthritis
• Symptomatic sarcoidosis

Critical Limitations and Cautions

Duration of Benefit

The therapeutic effect is modest and short-lived 4:

• Average duration: 2-4 weeks compared to saline 4
• Pain relief at 1-4 weeks, but no sustained benefit at 12-24 weeks 1
• This limited duration often leads to repeated injections (up to 4 annually) 4

Potential Adverse Effects

Cartilage toxicity concerns 5, 4:

• Recent evidence suggests repeated intra-articular corticosteroids may be associated with greater MRI-assessed cartilage thickness loss than saline 4
• Toxic damage to articular cartilage is a documented risk 5
• Repetitive injections may create an environment conducive to joint destruction 3

Systemic effects include 5:

• Increased blood glucose levels
• Reduced immune function and increased infection risk
• Secondary adrenal insufficiency (can last 4 weeks with 80mg methylprednisolone, occasionally up to 2 months) 1
• Higher risk of influenza with joint corticosteroid injections 1

Comparison to Other Treatments

Corticosteroids versus hyaluronic acid 1:

• Corticosteroids have considerably more evidence (19 high-quality studies) supporting use 1
• Hyaluronic acid shows inconsistent results and is NOT routinely recommended 1
• Corticosteroids are conditionally recommended over other intra-articular injections 1

Corticosteroids versus platelet-rich plasma 1:

• PRP shows promise with 2 high-quality studies, but demonstrates worse response in severe osteoarthritis 1
• Cost and safety concerns limit PRP use 1

Practical Considerations

Technical Aspects

Ultrasound guidance 1:

• Strongly recommended for hip joint injections
• Not required for knee and hand joints, though may improve accuracy

Dosing 6:

• Small joints: 10-20 mg methylprednisolone or triamcinolone
• Intermediate joints: 20-40 mg
• Wrist: 20 mg noninferior to 40 mg 6

When NOT to Use Steroid Injections

Avoid in 1, 3:

• Chronic low-back pain without radiculopathy (no long-term benefit)
• Situations requiring repetitive injections (risk of joint destruction)
• When infection risk is elevated (immunocompromised patients during COVID-19 pandemic should have infectious disease consultation) 1

Clinical Decision Algorithm

1. Confirm inflammatory component: Look for joint effusion, warmth, acute flare
2. Consider duration of symptoms: Acute presentations respond better than chronic
3. Evaluate prior response: Short-term pain at 3 days correlates with pain at 3 weeks 7
4. Limit frequency: Maximum 4 injections annually to minimize cartilage damage 4
5. Use as bridge therapy: Combine with other modalities (physical therapy, weight loss, oral NSAIDs) rather than as standalone treatment 1