Steroid Injections for Treating RA Symptoms

Corticosteroids or glucocorticoids are powerful anti-inflammatory drugs commonly used to treat a variety of medical conditions. They are not to be confused with anabolic steroids that are notoriously abused by athletes.¹ Anabolic steroids are associated with muscle mass gain and corticosteroids are connected with metabolism and immunity.

Most every RA patient has probably taken oral steroids in the form of pills or a dose pack that tapers down the dose over a period of time. Oral steroids are effective at providing quick reduction of RA symptoms although long-term use is generally discouraged and even short-term use is being questioned.² When taking an oral steroid, the drug goes throughout the entire body systemically. But there are other forms of steroids that are directly injected into a specific area of the body in an effort to treat RA related symptoms. Since being diagnosed with RA, I’ve had one steroid injection into my right knee, four into my left hip, one into my neck, and one into my right elbow. Sometimes they provided relief, other times I felt nothing. Joint injections are usually mixed with a numbing agent like lidocaine or Marcaine (Bupivacaine) in order to make the process more comfortable for the patient.³

Sometimes an injection may be coupled with an imaging contrast. For example, this week I had an injection into my left hip joint. The injection included a combination of a corticosteroid solution called Kenalog, some saline solution to insert fluid into the joint, and a contrast agent called gadolinium. A radiologist used a special x-ray called a fluoroscope that is like a movie x-ray allowing him to get the needle into the correct spot for the injection.⁴ Within a few minutes of getting the injection, I was in the MRI machine. The gadolinium helps make tissues more visible on the MRI so doctors can get a better idea of what’s going on with the soft tissue.⁵ The entire process is called an arthrogram.⁶

When a steroid injection is done on the neck or back, it is called a cervical or lumbar epidural spinal injection (ESI). These injections are also done using the guidance of a fluoroscope so the needle goes into the epidural space surrounding the spinal cord and not directly into the spinal cord. The goal is for the steroid to bathe the space around the offending joints and nerves so that inflammation is reduced.⁷

Steroid injections can provide anti-inflammatory relief for certain joints. They can also provide diagnostic information. If an injection helps, it gives information about the location of an area affected by joint damage. But steroid injections should be limited in that excessive use can cause damage to tissues. They are usually limited to several times during a year period.⁸

While not common, there are some potential complications with joint steroid injections. Since the skin is penetrated, there is a risk of infection. The steroid can damage tissues. There are some tissues that should be completely avoided. My orthopedic surgeon refused to give an injection into my damaged Achilles tendon because it can actually cause the tendon to tear and rupture.⁹ Area nerves, arteries and veins should be avoided. The skin in an area of the injection can loose pigment.¹⁰

Sometimes steroids are used during the infusion of an RA biologic medicine in order to combat any potential reactions or side effects. This is most common with those given via infusion including Remicade, Rituxan, Orenica, and Actemra. Before I receive a Rituxan infusion, a rather large dose of 80-100 mgs of liquid methylprednisolone steroid is injected directly into the intravenous line. The nurse injects the steroid slowly over several minutes in order to avoid what she calls a “head rush” from the powerful medicine. This dose usually gets me quite hyped up for the next 24 hours and sleep is difficult.

Corticosteroids are used for many inflammatory conditions and can be administered orally or via infection. If you have RA, it’s likely that you’ll experience both oral and injected steroids throughout the progression of the disease. Joint injections can provide temporary relief in a hurting joint. Make sure to speak to your doctor about the benefits and risks of the use of steroids.