About hydrocortisone injections
Hydrocortisone injections - or 'steroid injections' - are a type of medicine known as a corticosteroid. Corticosteroids are not the same as anabolic steroids.
Hydrocortisone injections are used to treat swollen or painful joints, such as after an injury or in arthritis.
The hydrocortisone is injected directly into the painful joint. This is also called an intra-articular injection. The joints most often injected are the shoulder, elbow, knee, hand/wrist and hip.
Hydrocortisone injections are also used to treat painful tendons and bursitis (when a small bag of fluid which cushions a joint gets inflamed). They're sometimes used to treat muscle pain when it's in a particular area.
The injections usually help relieve pain and swelling, and make movement easier. The benefits can last for several months.
Hydrocortisone injections are only available on prescription. They're usually given by a specially trained doctor in a GP surgery or hospital clinic.
In an emergency, medical staff may give higher dose hydrocortisone injections to treat severe asthma, allergic reactions, severe shock due to injury or infection, or failure of the adrenal glands.
Other types of hydrocortisone
There are different types of hydrocortisone, including skin creams, foam and tablets.
- Hydrocortisone injections for joint pain work by releasing the medicine slowly into the joint. This reduces pain and swelling.
- After an injection, your joint may feel better for several months - sometimes as long as a year.
- Some people get increased pain and swelling in the joint where the injection was given. This pain tends to go away after a few days.
- Hydrocortisone injections into the same place can be repeated up to 4 times a year - more often can cause long-term joint damage.
- Hydrocortisone injections can sometimes damp down your immune system so you're more likely to get infections. Tell your doctor if you come into contact with chickenpox, shingles or measles. If your immune system is damped down, these infections could make you very ill.
Who can and can't have hydrocortisone injections
Adults and children can have hydrocortisone injections.
Hydrocortisone injections aren't suitable for some people. Tell your doctor before starting the medicine if you:
- have ever had an allergic reaction to hydrocortisone or any other medicine
- have ever had depression or manic-depression (bipolar disorder) or if any of your close family has had these illnesses
- have an infection (including an eye infection)
- are trying to get pregnant, are already pregnant or you are breastfeeding
- have recently been in contact with someone with shingles, chickenpox or measles (unless you're sure you are immune to these infections)
- have recently had, or will soon have, any vaccinations
Hydrocortisone can make some health problems worse so it's important that your doctor monitors you.
Make sure your doctor knows if you have:
- any unhealed wounds
- high blood pressure
- an eye problem called glaucoma
- osteoporosis (thinning bones)
If you have diabetes and monitor your own blood sugar, you will need to do this more often. Hydrocortisone injections can affect your blood sugar control.
How and when to have them
A specially trained doctor usually gives the injection. If the injection is for pain, it may contain a local anaesthetic. You may also have a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.
You can go home after the injection but you may need to rest the area that was treated for a few days.
You can have a hydrocortisone injection into the same joint up to 4 times in a year.
If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.
The dose of hydrocortisone injected depends on the size of the joint. It can vary between 5mg and 50mg of hydrocortisone.
Will the dose I have go up or down?
The amount of hydrocortisone in the injection could go up or down in future. It depends on how well the previous injection worked, how long the benefits lasted and whether you had any side effects.
Most people don't have any side effects after a hydrocortisone injection. Side effects are less likely if only one part of the body is injected.
Common side effects
The most common side effect is intense pain and swelling in the joint where the injection was given. This usually gets better after a day or two.
You may also get some bruising where the injection was given. This should go away after a few days.
Serious side effects
With hydrocortisone injections, the medicine is placed directly into the painful or swollen joint. It doesn't travel through the rest of your body. That means, it's less likely to cause side effects.
Sometimes, though, hydrocortisone from a joint injection can get into the bloodstream. This is more likely to happen if you've had several injections.
If hydrocortisone gets into your bloodstream, it can travel around your body and there's a very small chance that you may have a serious side effect.
Tell a doctor straight away if you get:
- depressed (including having suicidal thoughts), feeling high, mood swings, feeling anxious, seeing or hearing things that aren't there or having strange or frightening thoughts - these can be signs of mental health problems
- a fever (temperature above 38C), chills, a very sore throat, ear or sinus pain, a cough, pain when you pee, mouth sores or a wound that won't heal - these can be signs of an infection
- sleepy or confused, feeling very thirsty or hungry, peeing more often than usual, flushing, breathing quickly or having breath that smells like fruit - these can be signs of high blood sugar
- weight gain in the upper back or belly, a moon face, a very bad headache and slow wound healing - these can be signs of Cushing's syndrome
You should also tell a doctor straight away if you get:
- swelling in your arms or legs
- changes in your eyesight
Some of these side effects, such as mood changes, can happen after a few days. Others, such as getting a rounder face, can happen weeks or months after treatment.
Children and teenagers
In rare cases, if your child or teenager has hydrocortisone injections over many months or years, it can slow down their normal growth.
Your child's doctor will watch their growth carefully while they are having hydrocortisone injections. That way they will be able to see quickly if your child is growing more slowly and can change their treatment if necessary.
Talk to your doctor if you are worried about your child having hydrocortisone injections.
Serious allergic reaction
It's extremely rare to have an allergic reaction to a hydrocortisone injection but if this happens to you, contact a doctor straight away.
A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.
The warning signs of a serious allergic reaction are:
- getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
- tightness in the chest or throat
- having trouble breathing or talking
- swelling of the mouth, face, lips, tongue, or throat
You can report any suspected side effect to the UK safety scheme.
How to cope with side effects
What to do about:
Pain in the joint after the injection: this gets better after a day or two. Rest the joint for 24 hours after the injection and don't do any heavy exercise. It's safe to take everyday painkillers such as paracetamol and ibuprofen.
Pregnancy and breastfeeding
It's usually ok to have a hydrocortisone injection while you're pregnant or breastfeeding.
However, hydrocortisone has occasionally been known to cause problems in the first 12 weeks of pregnancy.
For safety, tell your doctor if you're trying to get pregnant or if you're already pregnant before having a hydrocortisone injection.
Hydrocortisone injections and breastfeeding
It's safe to have hydrocortisone injections while you're breastfeeding. Only very small amounts of hydrocortisone get into breast milk so it's unlikely to be harmful.
Cautions with other medicines
There are many medicines that can interfere with the way hydrocortisone injections work.
It's very important to check with your doctor or pharmacist that a medicine is safe to mix with hydrocortisone injections before you start taking it. This includes prescription medicines and ones that you buy over the counter like aspirin, paracetamol and ibuprofen. It also includes herbal remedies and supplements.
Tell your doctor or pharmacist before stopping or starting any other medicines and before taking any herbal remedies, vitamins or supplements.
How do hydrocortisone injections work?
When will I feel better?
How many hydrocortisone injections will I need?
Does it hurt?
How well do hydrocortisone injections work?
Why do I need to be careful of infections?
Can I have vaccinations?
Do I need a blue steroid card?
Can I drink alcohol with it?
Are there any food or drinks I need to avoid?
Will it affect my fertility?
Will it affect my contraception?
Are other treatments available?
Can lifestyle changes help painful joints?