Corticosteroids are a class of steroid hormones (there are both natural and synthetic analogues) which are produced in the adrenal cortex and are secreted by the hypothalamic-anterior pituitary-adrenocortical (HPA) axis. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.
There are three types of corticosteroids:
- Glucocorticoids - anti-inflammatory agents with a large number of other functions
- Mineralocorticoids - control salt and water balance primarily through action on the kidneys
- Corticotropins - control secretion of hormones by the pituitary gland.
Synthetic corticosteroids are used as drugs. Injectable corticosteroids are used to treat inflammatory conditions such as synovitis, arthritis and tendonitis.
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Examples of injectable corticosteroids include:
Depo-Medrol
Kenalog
Celestone
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Injectable corticosteroids are used in localized injections to treat joint and tendon pain and inflammation. Corticosteroids reduce pain by reducing inflammation. Corticosteroid injections can provide months to years of relief.
Corticosteroids can also be used by systemic injection for allergic reactions, asthma and rheumatoid arthritis which is affecting many joints.
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The advantages of injectable corticosteroids include:
- the corticosteroid injections can be easily administered at a doctor's office
- the rapid onset of action (quick relief of symptoms)
- dependability
- minimal side effects
- relief of localized inflammation in a particular body area is more rapid and powerful than with traditional anti-inflammatory medications given by mouth
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Short-term side effects of injectable corticosteroids include:
- shrinkage of the skin at the injection site
- depigmentation of the skin at the injection site
- bacterial infection
- local bleeding at injection site
- soreness at the injection site
- reaction to the corticosteroid causing a flare up of inflammation
- weakened tendons
- increase in blood sugar levels in diabetics
- reduce body’s ability to fight infections
- injury to joint tissues
Long-term injectable corticosteroid side effects include:
- thinning of the skin
- easy bruising
- weight gain
- puffiness in the face
- elevation of blood pressure
- cataract formation
- thinning of the bones
- thinning of joint cartilage
- weakening of joint ligaments
The likelihood of occurrence of these long-term side effects depends on the dose of corticosteroid given and the frequency of treatments.
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The beneficial (anti-inflammatory) effects of injectable corticosteroids can last for many months, even years, if used properly. In some types of localized inflammatory conditions injectable corticosteroids can provide permanent relief.
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Corticosteroid injections are usually given by a physician in a physician’s office. The corticosteroid is drawn up into a syringe, usually along with a local anesthetic. The area over the injection site is sterilized with alcohol or Betadine. The needle is then inserted into the injection site and the corticosteroid solution is injected into the tissue or joint.
If the injection is into a joint, and there is excessive fluid in the joint, then some of the excess fluid is usually removed from the joint (before the corticosteroid injection) using separate needle and syringe.
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There can be some minor discomfort from the procedure. However, if local anesthetics are used this discomfort can be greatly reduced. Although there may be minor discomfort, relief from the pain of the inflammation occurs rapidly.
Smaller or damaged joints are more likely to experience minor pain when injections are performed compared to larger, healthier joints. There is also the small chance that nerves can be irritated during the injection procedure. Nerve irritation can be caused either directly by the needle during the injection or by the corticosteroid medication.
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