Contraindications to the injection of cortisone for knee pain and arthritis

 

Sometimes the doctor resorts to injecting cortisone into the joint if the main cause of joint pain is not clear, to narrow the list of possible diagnoses. This procedure is common in diagnosing hip and shoulder pain. For example, a doctor may recommend cortisone injections for persistent pain in the groin:

 

If there is improvement after the injection, the underlying problem is often the thigh.

If there is no improvement, the doctor may consider other diseases such as spinal injuries or sacroiliitis , both of which can cause thigh pain.

In the event of uncertainty of the diagnosis after the injection of cortisone, the doctor resorts to other diagnostic methods such as magnetic resonance imaging.

 cortisone injections are not a radical treatment for various causes of inflammation.

The effect of cortisone injections appears gradually, usually taking several days for its full effect.

 Repeated injections may affect the tissues surrounding the joints, such as ligaments, synovial sac, tendons and articular cartilage. For this: The time period between injections must be spaced for at least 4 to 6 weeks, and the injection is not done in the same place more than 3 times annually.

The doctor does not directly inject the tendons, even if they are the direct cause of the pain, but rather injects around them.

 Corticosteroids can reduce inflammation even if they are not injected directly into the affected tendon.

 Cortisone injections usually achieve a satisfactory result for most patients from the first injection of cortisone, and in the absence of expected relief, the injection is repeated after 4 to 6 weeks.

 If the patient does not feel better, it is unlikely that you will feel better after a third injection and is not recommended.

The doctor sterilizes the injection site well to avoid transmission of any infection to the patient.

Intra-articular cortisone injection may be accompanied by slight pain, so the doctor may use a local anesthetic to place the injection site, and sometimes the cortisone is mixed with an analgesic to relieve the pain of the injection and the pain of internal inflammation as well.

The doctor does not recommend the use of cortisone injections in:

·         The presence of a fungal infection or pus in the skin.

·         Infection of the patient with purulent arthritis .

·         Patients taking anticoagulant drugs.

·         In the event of a bone fracture.

Some patients worry about weight gain lingering in their minds as an inevitable side effect when treated

with cortisone.

 However, treatment with topical cortisone injections does not cause weight gain, but rather is caused by taking cortisone for long periods of time.

Later on, we'll look at the possible side effects of cortisone injections.

 

Cortisone damage and side effects

The side effects of cortisone vary according to the general health status of the patient, and according to the dose and drug form.

 

Oral cortisone side effects:

It is the most common drug form that exposes its users to side effects due to its effect on the entire body and includes the following:

• Weight gain as a result of its interference in body fat metabolism, so fat is concentrated in the abdomen, face and neck.
• Depression, insomnia, mood and memory disorders and other psychological effects.
• high intraocular pressure;
• High blood pressure and fluid retention in the body, causing swollen ankles.

When taking cortisone for long periods, as in cases of chronic diseases, side effects may reach more serious stages, such as:

• Having diabetes.
• Having stomach ulcers because cortisone damages the protective mucous lining of the stomach, and may also cause infections of the colon, esophagus and pancreas.
• It causes muscle weakness due to the breakdown of the protein that makes up muscle tissue.
• Osteoporosis because it interferes with the action of vitamin D.
• Infection of one or both lenses of the eye with cataracts.
• Slow wound healing, skin thinning and bruising.
• Reducing the secretion of adrenal hormones.
• Increased risk of infection due to suppression of the immune system.

Side effects of topical cortisone:

• Thinning of the skin and increasing its susceptibility to wounds and cracks.
• The appearance of bruises, red spots and acne.

Side effects of cortisone inhalation:

• Mouth and throat irritation and oral fungal infection. Which can be avoided by rinsing with water after each use of the sprayer.

Side effects of cortisone injections

Usually, the doctor does not recommend repeating cortisone injections more than 3 times in a year. Cortisone injections may cause:

• Increased blood sugar. And this ratio should be monitored in diabetics for two days after the injection.
• Temporary thinning, swelling and redness of the skin at the injection site.
• Temporary change in skin color.

An infection is transmitted to the patient during the injection, and this rarely happens due to the doctors’ interest in sterilizing the injection site.

Some tissue around the joint that was injected with cortisone may be damaged.

An allergic reaction to cortisone, which is extremely rare because cortisone is a derivative of cortisol naturally produced by the body.

 In the event that the patient knows that he is allergic to cortisone, he must inform the doctor so that he can use alternative treatment methods.

Contraindications to the use of cortisone

The doctor must be informed of the patient's medical history so that the doctor can prescribe cortisone in safe doses or exclude it from the treatment plan. Among these diseases:

• Liver diseases such as cirrhosis.
• Kidney disease.
• Thyroid disorders.
• diabetes.
• Previous infection with malaria.
• Osteoporosis.
• tuberculosis.
• Muscle disorders such as myasthenia gravis.
• Cataracts or glaucoma (glaucoma)
• Infection of the eyes with herpes infection.
• Gastric ulcer or ulcerative colitis and diverticulitis.
• Depression, psychological or mental problems.
• congestive heart failure;
• Hypertension.

cortisone and pregnancy

Some studies indicate that cortisone negatively affects the development of fetuses, and some other studies are still trying to prove the danger of its use during pregnancy.

 so the use of cortisone should be avoided during this period, except in cases of extreme necessity if advised by the attending physician, as well as during the breastfeeding period.

source:

by: Dr Asmaa Reda