1. About hydrocortisone injections
Hydrocortisone injections are used to treat swollen or painful joints, such as after an injury or if you have arthritis.
The hydrocortisone is injected directly into the painful joint. This is called an intra-articular injection. The joints most often injected are the shoulder, elbow, knee, hand, wrist or 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 is a type of medicine known as a steroid (or corticosteroid). Corticosteroids are not the same as anabolic steroids.
Hydrocortisone injections are only available on prescription. They're usually given by a specially trained doctor in a GP's 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.
NHS coronavirus advice
As long as you have no symptoms of coronavirus infection, carry on taking your prescribed steroid medicine as usual.
If you develop any coronavirus symptoms, do not stop taking your steroid medicine suddenly. Ask your doctor about whether you need to stop taking it or not.
Updated: 20 March 2020
Other types of hydrocortisone
There are different types of hydrocortisone, including skin creams, suppositories and tablets.
2. Key facts
- 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 their joint immediately after having the injection. This pain tends to go away after a few days.
- Depending on which joint is being treated, you may be able to have injections in the same place up to 4 times a year.
- Hydrocortisone injections can affect your immune system, so you're more likely to get infections. Tell your doctor if you come into contact with chickenpox, shingles or measles as these infections could make you very ill.
- If you have been having long-term hydrocortisone injections for a long time, you may need to carry a steroid emergency card. Ask your pharmacist or doctor if you do not have one.
3. Who can and cannot have hydrocortisone injections
Most adults and children, including babies, can have hydrocortisone injections.
Hydrocortisone injections are not 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 chickenpox, shingles or measles (unless you're sure you are immune to these infections)
- have recently had, or you're due to have, any vaccinations
Hydrocortisone injections 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
- weak or fragile bones (osteoporosis)
- type 1 or type 2 diabetes
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.
4. How and when to have hydrocortisone injections
A specialist doctor will usually give you your injection. This may be at your GP surgery.
If the injection is for pain, it may contain a local anaesthetic. You might 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 may be able to have a hydrocortisone injection into the same joint up to 4 times in a year. The number of injections you need depends on the area being treated and how strong the dose is.
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 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?
If you need a follow-up injection, the amount of hydrocortisone could go up or down. It depends on how well the previous injection worked, how long the benefits lasted and whether you had any side effects.
5. Side effects
Most people do not have any side effects after a hydrocortisone injection. Side effects are less likely if only one part of the body is injected.
If you’re having high doses of hydrocortisone injections, or you’re also taking other steroid medicines or tablets for fungal infections or HIV, you may get underactive adrenal glands as a side effect. Ask your doctor if you need to carry a steroid emergency card.
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 does not 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 your blood. This is more likely to happen if you've had several injections.
If hydrocortisone gets into your blood, it can travel around your body and there's a very small chance that you may have a serious side effect.
Call a doctor straight away if you:
- are depressed (including having suicidal thoughts), feeling high, mood swings, feeling anxious, seeing or hearing things that are not there or having strange or frightening thoughts – these can be signs of mental health problems
- have a high temperature, chills, a very sore throat, ear or sinus pain, a cough, pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
- are 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 diabetes or complications of diabetes
- have a "moon face" (a puffy, rounded face), weight gain in the upper back or belly – this happens gradually and can be a sign of Cushing's syndrome
- have swelling or throbbing in your arms or legs, or if you feel breathless or have chest pain – these can be signs of a deep vein thrombosis (DVT) or a blood clot
- have any changes to 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 monitor their height and weight carefully for as long as they're having treatment with hydrocortisone. This will help them spot any slowing down of your child's growth and change their treatment if needed.
Even if your child's growth slows down, it does not seem to have much effect on their overall adult height.
Talk to your doctor if you're worried. They will be able to explain the benefits and risks of giving your child hydrocortisone injections.
Serious allergic reaction
It's extremely rare to have an allergic reaction (anaphylaxis) to a hydrocortisone injection.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of hydrocortisone injections.
You can report any suspected side effect using the Yellow Card safety scheme.
6. Pregnancy and breastfeeding
Hydrocortisone and pregnancy
Hydrocortisone injections can be used in pregnancy and breastfeeding.
Your doctor will only prescribe hydrocortisone injections for you while you're pregnant or breastfeeding if the benefits of the medicine outweigh the chances of it being harmful.
Tell your doctor if you're trying to get pregnant or if you're already pregnant before having a hydrocortisone injection.
Hydrocortisone 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.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
For more information about how hydrocortisone can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.
7. Cautions with other medicines
There are many medicines that can affect 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 having them.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
8. Common questions about hydrocortisone
How do hydrocortisone injections work?
Hydrocortisone injections contain the active ingredient hydrocortisone. This is a steroid (or corticosteroid).
The injection releases the hydrocortisone slowly into the part of your body that is painful or swollen. Like other steroids, it works by calming down your immune system. This reduces inflammation and helps to relieve the pain and swelling.
When will I feel better?
A hydrocortisone injection usually takes a few days to start working – although sometimes they work in just a few hours.
How many hydrocortisone injections will I need?
If your pain and swelling gets better after a single hydrocortisone injection, you may not need another one.
If you have a long-term problem and hydrocortisone injections work well, you may carry on having them.
Doctors usually recommend waiting at least 3 months before having another hydrocortisone injection in the same joint.
Will the injections hurt?
The injection can be a little uncomfortable, but many people say they're not as bad as they thought they would be.
How well do hydrocortisone injections work?
Hydrocortisone injections usually help with pain and swelling for around 2 months. They can also make movement easier.
If you have a short-term joint injury, an injection will often help you start to move again so that your body can heal itself.
For long-term joint pain, an injection should help for a few months, but you may need further injections.
Why do I need to be careful of infections?
Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles. Your doctor may be able to prescribe a medicine to protect you.
Can I have vaccinations?
Before you have a vaccination, mention to the healthcare professional that you're taking a steroid.
It's possible that if you have a "live" vaccine around the time that you have a hydrocortisone injection, your immune system might not be strong enough to handle it. This could lead to you getting an infection.
Live vaccines include:
- shingles vaccine
- BCG (tuberculosis) vaccine
- yellow fever vaccine
- MMR (measles, mumps and rubella) vaccine
- nasal spray flu vaccine
Inactive vaccinations, like the injected flu vaccine, are safe.
If you need to have a live vaccine, check with the nurse or doctor that it's safe for you.
Do I need to carry a steroid card?
Steroid emergency card (red card)
If you are prescribed steroid medicines such as hydrocortisone injections your adrenal glands may not make as much of some of the hormones your body needs such as cortisol (known as the stress hormone). This is known as adrenal insufficiency.
It’s more likely to happen if you take high doses for a long time (especially tablets and injections) or if you regularly use different kinds of steroids at the same time (such as a steroid nasal spray and a steroid inhaler).
Your doctor or pharmacist will assess your risk of adrenal insufficiency based on the type and dose of steroids you’re taking, and may recommend that you carry a steroid emergency card. This card is the size of a credit card and fits in your wallet or purse.
If you need any medical or dental treatment, or are having surgery or an invasive procedure, show your steroid emergency card to your doctor or dentist. This is important so they know you are having steroid treatment and can give you extra steroids as needed.
Blue steroid card
If you have been having hydrocortisone injections for longer than 3 weeks, or you have been prescribed a high dose, your doctor or pharmacist will give you a blue steroid treatment card.
It tells you how you can reduce the risks of side effects. It also gives details of your doctor, how much prednisolone you take and how long the treatment will last for.
If you need any medical or dental treatment, show your blue steroid card to the doctor or dentist.
Can I drink alcohol with it?
Yes, you can drink alcohol before and after a hydrocortisone injection.
Are there any food or drinks I need to avoid?
You can eat and drink normally before and after a hydrocortisone injection.
Will it affect my fertility?
Hydrocortisone injections do not affect the fertility of men or women.
Are other treatments available?
There are other types of medicine for treating swollen or painful joints.
NSAIDs (non-steroidal anti-inflammatory drugs) are medicines that are used to relieve pain and reduce inflammation.
Some can be bought over the counter from pharmacies, while others need a prescription. They’re available as tablets and capsules, suppositories, injections, creams and gels.
NSAID creams and gels can help if you have muscle or joint pain in a particular part of your body, as they tend to have fewer side effects than tablets or capsules. They include painkilling creams such as ibuprofen or diclofenac. You massage these into the skin over the painful area.
Can lifestyle changes help painful joints?
There are other options that can help sore or swollen joints.
It might help to:
- improve your general fitness through regular exercise
- do an exercise programme to increase muscle strength around your joint
- apply hot and cold treatments to the joint
- use a walking stick or frame to support yourself (if your walking is affected)
- have electrotherapy (for example using a TENS machine)
It's best to ask for expert advice from a physiotherapist or occupational therapist.