From the Guidelines
Oral steroids are not recommended as a first-line treatment for bursitis due to the lack of evidence supporting their effectiveness and potential risks associated with their use. The most recent and highest quality study, 1, which was published in 2017, found that oral corticosteroids were not significantly more effective than other treatments, such as NSAIDs, in reducing pain and inflammation in patients with acute gout, a condition similar to bursitis.
Key Points to Consider
- The use of oral steroids for bursitis is not supported by strong evidence, and their effectiveness is unclear 1.
- Oral steroids may be associated with potential side effects, such as increased blood sugar, mood changes, insomnia, and fluid retention, which can negatively impact quality of life.
- Conservative measures, such as rest, ice, and physical therapy, should be tried first, and NSAIDs may be considered as an alternative treatment option.
- If symptoms persist or worsen, patients should follow up with their healthcare provider to discuss other treatment options and potential risks associated with repeated or prolonged steroid use.
Treatment Approach
When treating bursitis, it is essential to prioritize conservative measures and reserve oral steroids for severe cases that have not responded to other treatments. A typical treatment approach may include:
- Rest and ice to reduce inflammation and pain
- Physical therapy to improve range of motion and strength
- NSAIDs to reduce pain and inflammation
- Oral steroids, such as prednisone, may be considered for short-term use (less than 2 weeks) in severe cases, but their use should be carefully monitored and tapered to minimize potential side effects.
From the Research
Treatment Options for Bursitis
- Conservative measures such as rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises are often recommended as the first line of treatment for bursitis 2.
- In cases where conservative measures are not effective, corticosteroid injections may be considered as a treatment option 2, 3, 4.
- Oral steroids are not typically recommended as a primary treatment for bursitis, with most studies focusing on intrabursal steroid injections or oral anti-inflammatory agents 3.
Effectiveness of Oral Steroids
- There is limited evidence to support the use of oral steroids as a treatment for bursitis, with most studies examining the effectiveness of intrabursal steroid injections or other treatment options 2, 3, 4.
- One study compared the efficacy of an intrabursal steroid preparation with that of an oral anti-inflammatory agent, finding that the intrabursal steroid injection was more effective in reducing swelling and improving symptoms 3.
Alternative Treatment Options
- Surgical procedures such as bursectomy or trochanteric reduction osteotomy may be considered in rare cases of intractable symptoms 2.
- Other treatment options, such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications, may also be effective in managing symptoms of bursitis 5.