Proposed in case of joint pain, corticosteroid infiltrations do not leave indifferent. Some patients expect miracles, others fear them. Who’s wrong ? Who is right ? Answers from specialists.

Corticosteroid injections are intra-articular injections of a drug, most often cortisone.

“Corticosteroids are anti-inflammatories powerful”, explains Pr François Rannou, rehabilitation doctor and rheumatologist at Cochin Hospital (Paris). This is also the reason why infiltrations are only done in the acute phase, whatever the indication. They will not cure osteoarthritis, nor repair a tendon, nor resorb a herniated disc or solve a sciatica problem, but they will ease the pain.

Most of the time, infiltrations only come as a second line. “In fact, the decision is always made according to the benefit/risk balance”, specifies Pr Francis Berenbaum, head of the rheumatology department, Saint-Antoine hospital, Paris. “In the event of an outbreak ofosteoarthritis of the knee or hipor a sciatica, without particular history, one will in general prescribe initially nonsteroidal anti-inflammatories by oral way, and only then, in the event of failure, infiltrations. But when oral treatment is not recommended, for example in the event of a history of myocardial infarction, infiltrations will be offered as first-line treatment. »

Even if the indication is well put to the patient, some people don’t “respond” to corticosteroids : “We indeed observe an individual variation that we can neither explain nor predict”, acknowledges Professor Berenbaum. “That’s why you can’t promise in advance that the infiltrations will be effective, or for how long.”

The localization depends on the type of problem treated.

• For the joint problems (outbreaks of osteoarthritis, inflammatory arthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis): the infiltration takes place in the joint itself, and always under ultrasound control when it comes to the hip;
• For sciatica or cruralgia related to a herniated disc or a narrowing of the lumbar canal: the corticosteroid is injected into the spine, at the level of the nerve root concerned;
• For tendonitis: the infiltration is done around the tendon, and “only if the pain is very acute and allows you to move on to the essential stage of rehabilitation because the infiltrations weaken the tendons during the ten days to six weeks following the treatment. injection”, warns Dr Jean-Christophe Miniot, sports doctor.

The affected joint must be rested 24 to 48 hours after infiltration. The effects are felt a few days to a few weeks after the infiltration and their duration varies according to the patient and the joint.

” If the first infiltration is not enough, a second can be offered, preferably within 15 days,even a third, but no more if the results are not satisfactory,” says Professor Rannou. A scheme that is adjusted according to the case. For example :

• If it is a flare-up of osteoarthritis, and the first infiltration had little effect, or only over a week, some practitioners prefer to stop there. “There is little chance that the next one will be more effective”, observes Professor Berenbaum;
• “On the other hand, for sciatica or very painful cruralgia, it often takes two or three, a week apart to judge the result”.

In all cases, is the number of infiltrations limited to three per year? “This does not correspond to any medical reality,” says Professor Rannou. “If the infiltrations have given good results, but the pain returns six months later, there is nothing to prevent you from having another one”.

“This is especially the case when infiltrating into the hip or fingers of the hand, sometimes in the spine,” says Professor Rannou. Hence the prior application of a patch of local anesthetic to limit the pain.

“There may also be a pain within 24 to 48 hours after infiltrationthe volume of the product being able to temporarily compress the injection zone before being distributed”, adds Pr Berenbaum.

If pain persists, with feveryou must immediately consult to make sure that an infection has not developed, a rare but possible complication.

After infiltration there may be side effects that go away within hours or days (pain at the injection site, redness of the face or feelings of heat, headache).

Regarding the risks, it should be noted that corticosteroids can make some diseases worse. This is a side effect that requires caution. Thus, even if the diabetes is treated and balanced, you must monitor your blood sugar for the next 48 hours and, if it destabilizes, consult your doctor who will readjust the treatment. “If it is not balanced or treated, we avoid infiltrations which risk aggravating the problem”, explains Professor Berenbaum. Same thing in case ofuncontrolled high blood pressure or of glaucoma.

“Two studies carried out in people suffering from osteoarthritis of the knee and treated with infiltrations every three months for two years, did not show significant damage to the cartilage of the joint “, reassures Professor Berenbaum.