1. 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'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.
Other types of hydrocortisone
There are different types of hydrocortisone, including skin creams, foam 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 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.
3. 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
- weak or fragile bones (osteoporosis)
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 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.
5. 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.
Call 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 call 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 (anaphylaxis) to a hydrocortisone injection but if this happens to you or your child, contact a doctor straight away.
Immediate action required: Call 999 or go to A&E 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 to the UK safety scheme.
6. How to cope with side effects
7. 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.
Tell your doctor if you're trying to get pregnant or if you're already pregnant before having a hydrocortisone injection.
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.
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.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. 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.
9. Common questions
How do hydrocortisone injections work?
Hydrocortisone injections contain the active ingredient hydrocortisone which is a corticosteroid or 'steroid'.
Hydrocortisone injections release the steroid slowly into the part of your body which is painful or swollen. The steroid damps down immune system overactivity in the area and reduces inflammation. This in turn 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 within 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 that you shouldn't have a hydrocortisone injection into the same joint more than once every 3 months.
Does it 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 a blue steroid card?
If you have regular hydrocortisone injections, your doctor may give you a steroid card. Carry this with you all the time.
The card, which is usually blue, is the size of a credit card and fits into your wallet or purse. It gives advice on how you can reduce the risks of side effects. It also gives details of your doctor, how much hydrocortisone you're getting and how long your treatment will last for.
If you're having long-term treatment with hydrocortisone injections and you don't have a blue steroid card, ask your doctor for one.
If you need any medical or dental treatment, show your 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 a other types of medicine for swollen or painful joints.
There are also painkilling creams such as ibuprofen, diclofenac, or capsaicin cream. You massage these into the skin over the painful area.
If these treatments don't work, your doctor can prescribe stronger painkillers such as naproxen and codeine.
Can lifestyle changes help painful joints?
There are other options which 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 to support yourself
- have electrotherapy (for example a TENS machine)
It's best to ask for expert advice from a physiotherapist or occupational therapist.