Question
I have had RA since June 2001 for the first 18 months I had steriod injections every 2 months intially and the every 3 months after that while I went through the DMARD’s without sucess. I am now into my fourth year of RA and on my second TNF therapy and yet between Febuary and July I have had 4 injection 2 into muscles and 1 to each of my hips. I always thought that the injections were short term measures until I was stable. What I would like to know is it safe to have had this many? I know that I have definetley had over 20 injections and I am only 29. This really concerns me as I getting paranoid about the risk of osteoporosis. I know of people being refused injections and they can only have 1 or 2 a year.
Answer
The risk and benefit of the steroid injections has to evaluated in the context of how severe your disease is and whether or not the alternatives are working. It sounds like your disease is both severe and many alternatives have been tried without success. Intramuscular injections of steroids have many of the same side effects of oral daily prednisone such as osteoporosis, increasing the risk of cardiovascular disease, increasing risk of infections. Intramuscular injections are not harmful, its just another way of delivering the steroid. Intraarticular injections (into the joint)can weaken the ligaments and tendons of the joint by delaying healing, but this is balanced by the fact that uncontrolled inflammation rom RA can also damage the joint. Unfortunately, steroids by injection into the muscle or joints are often the only alternatives to keep people functional. Taking all these factors into account is the “art” of medicine.
