Cortisone steroid shots in the knee, shoulder, ankle, or back are a common treatment to manage swelling and reduce pain. In the doses commonly used (milligrams), these drugs are very powerful anti-inflammatories. However, these doses may be too powerful, as research shows the array of cortisone steroid shots side effects are many and negative. These include creating problems with blood sugar in diabetics, changing the normal cortisol control system in the body, and killing off cartilage and stem cells. For example, a recent study looked at what happened to patients after a steroid epidural (for low back pain and sciatica) and an intra-articular (inside the joint) injection of steroids. In diabetic patients, there were significant increases in blood sugar that lasted for about a week. Most concerning, were changes in the body’s own cortisol system that lasted for more than 3 weeks when patients received these steroid shots epidural. This cortisol suppression caused by steroid epidural shots throws off the body’s ability to manage infections, control blood sugar, and regulate other important body functions involved in the metabolism of processing foods. Is there other evidence showing that steroid shots may be a problem? Repeated joint injections of steroids have been associated with greater cartilage breakdown in animal models. In our closest animal relative (primates), repeated steroid shots have been shown to cause ligament failure and breakdown. Even at much lower doses than those commonly used by doctors to inject into joint (about 100 times less), certain steroids still kill cartilage cells. In particular, a steroid suspension containing the preservative benzalkonium chloride was very toxic toward cartilage cells, with the preservative being the main offender. Even without the preservative, steroids have still been shown to kill cartilage cells (called chondrocytes). Even steroids given orally to help swelling can lead to cartilage degeneration. In particular, steroids combined with local anesthetic (the most common way steroid is injected into joints), makes the steroid even more toxic to cartilage cells.How do steroids impact your stem cells? The same. In this study, steroids reduced the ability of bone stem cells to make new bone. This fits with other studies that show why some patients on oral steroids can develop avascular necrosis of the bone (death of bone maintaining stem cells).
Is there a better way? Yes. First, for injection into joints, we’ve all but abandoned the use of milligram dose steroids. Instead, our experience with culturing mesenchymal stem cells has taught us that the body responds much more appropriately to 1,000,000 times less steroid. So rather than milligram dose, we use a million times lower dose of nanograms. In these dose ranges, lab research has shown a net positive to stem cell health rather than a net negative. As noted above, high dose steroids in the epidural space (the most common form of non-surgical injection treatment for a disc bulge or herniation causing sciatica), can have more wide reaching negative effects on the body. As a result, we offer patients the option of using the growth factors from their own platelets in the Regenexx-PL-Disc procedure.