Steroid Injections for Rheumatoid Arthritis. Should you get cortisone shots for RA? We discuss injections into joints in this podcast.
Clint – Good day, it’s Clint Paddison here, and I’m with my daughter, Angelina. How are you, Angelina?
Angelina – Good.
Intra-articular Corticosteroid Injection For Rheumatoid Arthritis
Clint – Today, we’re going to talk about intra-articular corticosteroid injections for rheumatoid arthritis. In other words, steroids jabs directly into the joints. That doesn’t sound very nice, does it? It’s very painful, but there are lots and lots of reasons why we might want to do this. So we’re going to explore that in this video. What we’re going to cover the following things. First of all, who it is for, and I’ve got a little metaphor about how we should decide if this is a suitable treatment for us. What have we got written here?
Angelina – Who is this for? Metaphor, Bugs in couch.
Systemic DMARD vs Local Injection
Clint – That’s right. I’ve got a metaphor for bugs in a couch. Now, what this means is that if you imagine a house, right? Being your body and Angelina, imagine if all of different rooms in your body are all the different joints. So it’s like an enormous mansion. And you’ve applied some pesticide by taking a pill or something in your body that goes through the air conditioning unit into every room of the house to kill the bugs that are in all the rooms. But what if you only have bugs in one room? Then you’re putting in something into the air conditioning unit that’s going through the whole house just to try and affect some of the bugs that are only occupying one room. So what we can do in that situation is just attack the bugs directly and we can go in and put an injection straight into that one joint that’s not responding and really take care of the bugs in that room because we actually have particles from bacteria in our joints that are coming from our gut. Did you know that?
Clint – Inside your tummy you’ve got trillions of bugs in some of them enter into our bloodstream when we have something called leaky gut. In other words, if you’ve got one or two joints that aren’t responding well to your treatment, then perhaps a cortisone injection can be for you. So what about this next question?
Intra-articular Cortisone Injection
Angelina – What is an intra-articular cortisone injection?
Clint – What it is, is you either at the rheumatologist office or get a referral from your doctor and go to a special clinic where they use an ultrasound to find exactly where to put a needle right into your joint. And they put a whole bunch of steroids, which is this anti-inflammatory liquid right into your joint. And when they put it in the joint, they really squeeze it in. So the joint puffs right out, the skin expands and it gets right in there to kill the bugs. And in this case, the bugs are inflammation to reduce inflammation, and that goes right into the joint.
Where Can I Have A Steroid Shot?
Angelina – Where can you have them done, in my experience, variation in results? Systemic relief.
Clint – That’s right. So where can you have them done? Anywhere you have a joint. You can have them in your feet and your knees. You can have them done in your fingers, in your elbows. And those are the locations I’ve had them. And you can also have them in other joints as well, anywhere you have a joint. And my experience in variation has been one that has both successes and also non-successes. Especially when I’ve had injections into my fingers and also my knee, I’ve had tremendous results over the years. In fact, before you were born, Mommy and I went to get married in Hawaii and before we left my doctor said, Why don’t you get an injection into your knee? Because you’ll be able to dance at your wedding. Because all the things that I had done over the last year before that couldn’t get rid of the inflammation in my knee, even though everything else in my body was improved, but my knee would not improve. My doctor says have a cortisone injection and guess how long that lasted?
How Long Do Steroid Shots Last?
Angelina – How long?
Clint – 10 years. That’s how long the injection helped me. Was great, right? It only cost a few hundred dollars and it gave me years and years and years of relief. So that was a great one. Fingers have worked tremendously well for me over the years as well.
The Science – Steroid Shots Into Joints
Angelina – The Science Literature Review.
Clint – That’s right. Let’s have a look at the science. Let’s look at the literature review because it doesn’t matter what I say. Let’s find out what the science says about this. Okay. The science is actually surprisingly limited given the amount of frequency that these injections are used. It’s almost so widespread, the use of these steroid injections that they don’t do that many studies on them because they’re so effective. They think we don’t need to try and prove if it works or not, and we can see that it’s working. I had to go right back to 1990 to find a study that gave a risk-benefit assessment. And they said intra-articular injections with steroids may offer additional help in the treatment of inflammatory joint diseases. That’s like rheumatoid and ankylosing spondylitis, and so on. The major side effects of the systemic effects of the steroids. What that means is when you put it, say, in your elbow or your knee, a lot of it leaks out of the joint, gets into your bloodstream, and the steroid goes all throughout your body. Now, if you take steroids on a regular basis, there’s a lot of side effects of that, which is why daddy does not recommend long term taking of oral steroids, like even one milligram a day. Daddy’s never taken those steroids because he knows that it can really affect the tummy. And remember I said before that if we mess up the tummy, stuff can get into our bloodstream, the bugs. Right? And so we don’t want that. But you get a little bit of that with these injections into the joints and for a few days afterwards, your whole body feels really like better because it just leaks into the blood. And the other side effects include infectious arthritis, which rarely, if ever happens. That’s an infection at the injection site, which is I think the statistics are 1 in 4000, and cartilage damage. So you don’t want to do these too often because there’s a slight damage of cartilage. But, Angelina, do you think it would be better to have inflammation in a joint that goes on and on for months and months and months and months and really hurt the cartilage or get just a little bit of cartilage damage by having one injection just once.
Angelina – There’s a bit of cartilage damage. Having one injection just once.
Clint – Yes. And that’s what I think. If you’ve got one joint that’s really bad and the rest are pretty good, then this could be a really good option. The study says these side effects are infrequent, which means not very common and mostly preventable. Steroids are of little effect in radiological progression. That means if you go and get an x ray and you have a look and see whether or not the steroid caused damage to your joints, it mostly says that it doesn’t. Most important limitation of liberal use. Liberal means use all the time or freely. So you just don’t want to do it too often. They are a powerful suppressant for inflammation and pain for a varying length of time, which depends on the preparation use, so there is variation. I had some times on my elbows and it didn’t do anything, nothing that was frustrating for me.
Clint – In some other studies like those on juvenile idiopathic arthritis. It says that systemic, controlled and prospective research is needed because there’s not a lot going on in that area of research with these. But it’s a safe and effective method for treating synovitis. So there’s no sort of contraindication with JIA, according to the studies, but more studies need to be done. Every study says we should do more research in this area. It makes it look like they’re not wasting their time studying that. And because we never, ever know the full truth, we only get a portion of the truth every time we do some studies.
Steroid Shot – Knee Osteoarthritis
Clint – In knee osteoarthritis, it shows that it’s an effective treatment. And this study, if you’re not watching online, but this is I’m looking at the studies here in the video version of this. This one’s called intra-articular injections in knee osteoarthritis, a review of the literature. And then if we come to the very bottom, we always go to the bottom and look at the conclusions and we see that it is an effective treatment. But there are some other treatments and we’ll talk about them in a second, because back on our slides that we’re referring to, we’re going to talk about those two. You’ll be able to read them out in a minute. Again, further studies are needed, but it can delay surgical treatment, which is great. And then finally, here’s a good study because it talks about basically these steroid injections into a single joint. That’s what we’re talking about here for a non-responding joint. The conclusion or it says the clinical bottom line. See if you can read out. I’ll read the first half. You read the second.
Clint/Angelina – The available evidence suggests that a single intra-articulate injection of steroids significantly reduces pain, tendernes, and stiffness and increases mobility in patients with acute Rheumatoid Arthritis.
Clint – That’s right. Pain, tenderness, and stiffness improvement. So if you haven’t had a cortisone injection into a joint and that joint is the only one that’s really affecting your quality of life, the scientific evidence really suggests that this could be a good way to go. Okay, Angelina, let’s go back to our slides and then we will finish up our little video here. So we’ve done our literature review and now it’s time for this one. Any concern that one read this out.
Side Effects Of Steroid Shots
Angelina – Concerns pain and frequency ejects injection. Systemic release.
Clint – We did well, we actually covered this already, I realize. So the concerns are mostly with regard to the pain of the injection site, it can be painful. The knee is actually the least painful of the ones that I’ve had a big joint. Right. So there’s plenty of space and the amount of fluid that goes in doesn’t cause the joint capsule to feel like it’s going to burst like a balloon. The little joints, especially the fingers, can be very painful, but I believe that 10 seconds of pain can be better than 10 years of pain. And that was the case for my left knee.
Clint – Frequency. The rheumatologists tend to have a different guideline around this depending on the current quality of the joint cartilage, the amount of cartilage you have in a joint. But, no one’s really getting them done more than four times a year in a single joint and it’s closer to a couple of times, two times a year in a single joint. But again, talk to your doctor. Infections are rare and the systemic release of the steroid we’ve talked about.
Alternatives To Steroid Shots In Joints
Angelina – Alternatives, Hyaluronic Acid, PRP, ozone.
Clint – That’s right. So there are some alternatives to cortisone injections. One of them is this hyaluronic acid. I’ve never had that injection and people with rheumatoid don’t tend to get it. Why is that? It’s because it’s suitable to give you an extra 6 months, 12 months, maybe 18 months. If you’ve got an osteoarthritic knee that needs a knee replacement. With rheumatoid, there tend to be lots of inflammation in the joint and therefore it’s not a great option. But talk to your doctor about it. It may apply if your knee in particular is low in inflammation. Next, PRP joint is platelet-rich plasma injection and these tend to don’t have as many risks associated with them in terms of cartilage degradation, that’s an option. But again when a joints inflamed, talk to the doctor about that. And then ozone I’ve listed here for completeness. Ozone can be a great intervention in a joint that is nearing the end of life that doesn’t have inflammation and is in a body that is low inflammation. It’s a bit of a complicated reason for that, but ozone stimulates some oxidative stress. The body can adapt and generate some antioxidants which can assist with cartilage development. And I’ve seen some medical professionals present ozone intervention before and after X-rays online, and some of them are very impressive. But it’s something that you would need to investigate. The doctor who is excellent in this area is based in California, Dr. Robert Rowan. You can Google him if you’re interested in looking at some before and afters of ozone-treated joints. But remember, it’s a little bit dicey when it comes to rheumatoid because there’s already so much oxidative stress in the joint. So personally, I don’t recommend ozone for inflamed joints. So we are up to the.
Angelina – Last one.
Clint – That’s right.
Angelina – The last one is summary.
Clint – What we’ve established is that the intra-articular cortisone injection can be a great idea if you’ve got one or two joints that are outliers, ones that aren’t responding to all the natural things that you’re doing. This science says that they’re safe. Whilst we are aware that there is a problem if you have them too often so your rheumatologist won’t allow that or should be monitoring that and there can be some cartilage degradation as a result. So it’s whether or not one injection from time to time is worth the little bit of pain and also the little bit of cartilage impact. In my personal view, if you’re suffering very chronic long-term inflammation in that joint that that is a wise thing to investigate with your doctor rather than knowing your joints are being impacted so much by the inflammation. Again, only when there’s one or two joints impacted because if multiple joints are inflamed, you’re better off talking about a disease-modifying drug or a biologic drug. So, Angelina, any questions that you have after going through this? Thanks very much for helping me out with this video. Would you like to do another one in the future?
Angelina – Yes.
Clint – Well, thank you very much. Hopefully this helps everyone say bye bye bye.
Angelina – Bye.