Steroid injections are generally used to reduce inflammation and pain.
We will look at the guidance on the frequency of these injections. There is some evidence from studies on people with rheumatoid arthritis suggesting that multiple steroid injections in the same joint are safe to administer (1). However, injection therapy frequency must be seen in the context of the individual patient. In very young patients, repeat injections are avoided, if possible, given their young age and the possibility that more injections could be required, and only a finite number of repeat injections can be given.
However, there may not be any other treatment options available for elderly patients, such as those with severe pain and/or dysfunction, especially if a previous steroid injection has been administered and was successful for a long time.
There are limitations to the maximum frequency of steroid injections that can be given. It is generally accepted that no more than 3 steroid injections in any one joint should be given per year.
Again, context is everything here. I think that many practitioners would hesitate to do 3 injections/year every year in perpetuity. And again, in young people, most would agree that it is inappropriate to continue with repeat steroid injections x 3 in the same joint year after year. Even in older patients, most practitioners would also be quite careful, but if no other options exist and the patient does get very good pain relief, then in some instances, more than 3 in total might be given.
Another factor to consider is the amount of time between injections that should be allowed before a repeat steroid injection can be administered. NHS guidelines https://www.nhs.uk/conditions/steroid-injections/ suggest that there should be a 3-month gap between steroid injections, although context is everything here and in specific cases, a steroid injection given after 6 weeks might be acceptable.
Side-effects: It is well-known that long-term, excessive use of steroid injections can lead to significant structural damage such as: Thinning of the soft tissue and skin and muscle tissue, weakening of cartilage and bone, increase the risk of joint infection and possible increased glucose levels leading to diabetes. Please also see this link to a post on the side effects of steroid injections.
- Combe B. Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol. 2007;21: 27-42.