“Risks of corticosteroids?”
I developed osteonecrosis in my hip several years ago after receiving IV methylprednisolone. Since then I have been careful to avoid steroids.
My current primary care provider recently discovered spondyloarthritis on an x-ray and told me it was most likely due to normal wear and tear. I have no pain or stiffness or any other symptoms. Regardless, she has recommended cortisone shots into my spine to treat it.
I am trying to weigh the risks and rewards of having this done and hope someone can explain a few things to me:
1. Since systemic steroids caused so much damage to my bones before, should I also be concerned that intraarticular steroids could damage my bones as well?
2. Of what benefit are steroids to an asymptomatic spine?
Thank you for your time.
My current primary care provider recently discovered spondyloarthritis on an x-ray and told me it was most likely due to normal wear and tear. I have no pain or stiffness or any other symptoms. Regardless, she has recommended cortisone shots into my spine to treat it.
I am trying to weigh the risks and rewards of having this done and hope someone can explain a few things to me:
1. Since systemic steroids caused so much damage to my bones before, should I also be concerned that intraarticular steroids could damage my bones as well?
2. Of what benefit are steroids to an asymptomatic spine?
Thank you for your time.
Female | 53 years old
5 Answers
Short answer - There is absolutely no benefit of injecting steroids into asymptomatic spine.
Addressing your second question first, if you have NO PAIN, then I do not recommend any injections.
Regarding the other question, it is a matter of dose and distribution. The amount of steroids that the rest of the body sees after injecting a joint is minimal, and very very unlikely to contribute to further issues regarding AVN
Regarding the other question, it is a matter of dose and distribution. The amount of steroids that the rest of the body sees after injecting a joint is minimal, and very very unlikely to contribute to further issues regarding AVN
Generally facet joint injections do not lead to osteonecrosis as iv steroids or long treatment with oral steroids do. So if you had significantly painful back this may be worth trying. If you are a symptomatic then you should not have any steroids. Keep weight under control, start a regular spine stretching and strengthening. Good regular diet, proper lifting and appropriate life style changes will all help. Good luck.
No benefit to steroid injections for asymptomatic findings on your spine.
It’s time to get a new primary care doctor; no one in the orthopedic world would treat any sort of arthritis seen on X-rays and, as you say, clearly asymptomatic. Every physician knows chronic treatment with systemic corticosteroids has long term side effects and avascular necrosis (especially in the hip) is a potential problem. Normally, steroid injections, if given properly and with a proper interval between shots, should be extremely safe. Go to an orthopedic surgeon if you are concerned about your spine and you want a good musculoskeletal evaluation. There are many simple things that can be done if you wish to remain free of pain and active.
