August 25, 2020

Injections for arthritis pain: What are my options?

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Have you ever wondered if injections for arthritis might help your chronic joint pain? Here’s what to know about the options.

Joint injections can help ease osteoarthritis pain, but not all injections have the same effect. We asked Leon Scott, M.D., of Vanderbilt Orthopaedics Division of Sports Medicine to compare steroid, hyaluronic gel, platelet-rich plasma and stem cell shots, and explain the pros and cons of each type of injection.

Steroid injections

Steroid injections are a classic tool for controlling pain inside the joints. “Within two days to two weeks, people will have a dramatic improvement in pain in most cases,” Scott explained. Steroid injections are used to treat osteoarthritis pain. They aren’t meant for discomfort resulting from a trauma such as a fracture.

One drawback of steroid injections is that, although the pain relief is fast, the effect doesn’t last that long — usually one to three months, Scott said. A growing concern, based on recent studies, is that repeated steroid injections could damage and deteriorate joint cartilage over time, he added. Doctors should also explain the risk of temporary increased blood pressure, increased blood sugar, altered behavior or sleep, and skin changes like flushing.

“I think a steroid injection is a great tool,” Scott explained. “If you are going on a vacation, if you have a family member’s wedding coming up, if you have a big event and you do not want that pain to hurt you during that month, a steroid is probably the tool for you.”

A steroid injection can also be a helpful option for individuals who experience repeated stiffness or inflammation in a joint after a minor tweak at the gym. “Maybe it feels tight or swollen, but the exam is otherwise normal,” he explained. “Steroid for a young person might just be enough to flip the switch so it can cool down enough to it to heal back up again.”

Hyaluronic acid gel injections

These are commonly known as visco-elastic, “rooster-comb” or “gel” injections. The theory behind them is that they can boost joint lubrication and reduce inflammation. In people with osteoarthritis, hyaluronic acid, a substance that’s naturally in joint synovial fluid, deteriorates. “Hyaluronic acid is a major component of the netting and cushy bedding of cartilage known as extra-cellular matrix,” Scott explained.

The drawback of gel injections when compared to steroid injections is that they may not provide as much pain relief, Scott said. “But we believe gel injections are safer for the joint when it comes to repeated injections, and when people do have noticeable improvement in pain, the effect does last longer — about six months,” he added. Another drawback is cost. Some insurance companies don’t pay for gel injections, leaving patients paying about $1,500 out of pocket.

PRP injections

With these injections, platelet-rich plasma is injected into the joint. “We take a sample of blood and then concentrate the platelets out, and in some cases, activate them a certain way, and then inject them into the knee,” Scott said. Platelets are fragments of certain cells in the blood that carry growth-factor molecules along with other molecules known to signal the healing process. Scott explained that the theory behind these injections is to inject a concentration of platelets where they typically don’t go, such as the joint. “That may encourage tissue to remodel, heal and potentially reduce or at least better control some of the inflammatory processes that may be associated with pain,” he added.

Platelet-rich plasma can be quite effective at pain management. “At six months, 75 percent of patients say, ‘Yeah, this was worth it,’” Scott said. “That’s compared to 55 percent for steroids and compared to 30 percent for hyaluronic acid.” However, these injections can also have high out-of-pocket costs. Patients may pay $500 to $1,500 per injection. “If you have evidence of intact cartilage,” Scott said, “then I recommend PRP. But people have to realize it’s an investment.”

Stem cell injections

The concept behind stem cell injections is similar to that of PRP injections. Stem cells are taken from elsewhere in a patient’s body, such as bone marrow or fat tissue. Then they are then immediately injected into that patient’s joint. In theory, the injected stem cells act upon stem cells already in the joint and encourage them to “wake up” and repair damaged tissue, Scott explained. However,  the cost can be prohibitive. A patient will often pay $7,000 out of pocket for a stem cell injection. Yet, this type of injection has not been proven to be more effective than platelet-rich plasma.

A word of caution to consumers considering injections called “stem cells” that come from laboratories that use tissue donated from other people, commonly from umbilical cord or amniotic tissue: “Avoid these injections,” Scott said. “They contain no living stem cells, usually just dead tissue. At best, they are given by well-intended but uninformed medical providers, and at worst, by fraudulent profiteers.”

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Need help?

If you are dealing with an injury, facing surgery or coping with chronic pain, Vanderbilt Orthopaedics offers a full spectrum of care. Our specialists work with you from evaluation and “prehab” through physical therapy and, if needed, surgery. We’ll help you get back to doing the things you love, pain-free. To make an appointment, call 615-936-7846.

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