Cortisone Shot Risks: 7 Things to Know

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1. Repeated Cortisone Accelerates Cartilage Damage

This is the most important risk that many patients are never clearly told about.

Multiple studies — including a landmark JAMA trial and recent RSNA imaging research — show that regular cortisone injections speed up the breakdown of cartilage in arthritic joints.

The McAlindon trial (2017) gave one group cortisone every 3 months and another group saline placebo. After 2 years, the cortisone group had significantly more cartilage loss on MRI. The troubling part? They did not have better pain relief than the placebo group.

What your doctor may not emphasize

Many providers mention that cortisone “wears off” over time, but fewer explain why — or that the joint may actually be getting worse faster because of the treatment itself.

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2. Cortisone Relief Is Temporary — and Gets Shorter Over Time

If you have noticed that your cortisone shots seem to last less and less time, you are not imagining it.

Cortisone addresses inflammation, not the underlying problem (worn cartilage, degraded joint fluid). As the arthritis progresses — potentially accelerated by the cortisone itself — each injection has a harder job to do and a shorter effect.

If your cortisone barely lasts a month, that is a signal — not that you need more cortisone, but that you need a different approach.

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3. There Are Strict Limits on How Many You Can Safely Receive

Most patients do not know there is a recommended ceiling on cortisone injections.

Current guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and other organizations recommend no more than 3-4 cortisone injections per joint per year, with a minimum of 3 months between injections.

What to ask

“How many cortisone injections have I had in this joint total, and are we within safe limits?” If your provider cannot answer this question, that itself is a concern.

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4. Cortisone Can Mask Worsening Disease

Cortisone is very effective at reducing pain in the short term. That is both its benefit and its danger.

By suppressing pain, cortisone can create a false sense of improvement. You feel better, so you assume your knee is doing well. But underneath the pain relief, the arthritis may be progressing — and the cortisone itself may be contributing to that progression.

This is particularly concerning for patients who:

• Resume high-impact activities after cortisone without protection
• Skip follow-up imaging because “the shot is working”
• Delay discussions about long-term treatment strategies
• Never learn that their arthritis stage has advanced

The better approach

Treatments that provide relief while also protecting joint structure — like hyaluronic acid injections combined with physical therapy — allow you to manage pain without ignoring the underlying problem.

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5. Evidence-Based Alternatives Exist

This may be the most important thing patients are not always told: cortisone is not your only option.

Many patients receive cortisone because it is what they have always been given, or because they assume it is the only injection treatment available. In reality, several alternatives have strong evidence behind them:

Why your doctor may not have mentioned these

Some providers default to cortisone because of familiarity, speed (it takes less time than discussing alternatives), or assumptions about insurance coverage. Others genuinely believe cortisone is the best first option. But medical consensus is shifting.

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6. Your Insurance Probably Covers Alternatives

One of the most common reasons patients stick with cortisone is the belief that alternatives cost too much or are not covered by insurance. In most cases, this is not true.

What to do

Before your next cortisone injection, call your insurance company or ask your provider’s billing department: “Does my plan cover hyaluronic acid injections for knee arthritis?” You may be surprised by the answer.

For Medicare beneficiaries specifically, we have a detailed Medicare gel injection coverage guide.

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7. There Are Specific Questions You Should Ask Before Every Injection

Knowledge is your best protection. Before accepting any cortisone injection, ask your provider these questions:

You are not being difficult by asking these questions. You are being an informed, engaged patient — and most providers respect that.

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When Cortisone Is Still the Right Choice

This article is not arguing that cortisone is always wrong. There are situations where it remains the best option:

The risk is not in occasional, thoughtful cortisone use. It is in the pattern of routine, repeated injections as the sole management strategy — which is how cortisone has been used for many patients for years.

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The Bottom Line

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Frequently Asked Questions

Is cortisone dangerous?

Cortisone is not inherently dangerous when used appropriately. The risks increase with repeated, frequent use. Occasional cortisone injections (1-2 per year) for acute flares carry much less risk than routine injections every 3-4 months. The key is informed, judicious use.

How many cortisone shots is too many?

Most guidelines recommend no more than 3-4 per joint per year. However, even staying within that limit may cause cumulative cartilage damage over years. The newer trend is to limit lifetime cortisone exposure and shift to alternatives for ongoing management. Read more about cortisone frequency.

Can cortisone damage be reversed?

Cartilage damage from cortisone injections is generally not reversible. Cartilage has limited ability to heal itself, which is why preventing further damage is so important. This is also why the shift toward cartilage-preserving treatments like hyaluronic acid matters — it is better to avoid the damage than to try to repair it.

Why do doctors still give cortisone if it causes damage?

Several reasons: cortisone provides fast, reliable pain relief; it has decades of clinical familiarity; it is inexpensive and easy to administer; and the cartilage-damage research is relatively recent. Medical practice takes time to catch up with new evidence, though the shift is clearly underway.

Are gel shots a good alternative for everyone?

Gel shots work best for patients with mild to moderate knee osteoarthritis. Response rates are generally 60-80%. They may be less effective for severe bone-on-bone arthritis, though some patients with advanced disease still benefit. Your doctor can help determine if you are a good candidate.

What if my doctor dismisses my concerns about cortisone?

If your provider is not willing to discuss the research or consider alternatives, you have the right to seek a second opinion. The evidence on cortisone risks is published in top-tier medical journals (JAMA, AJR, RSNA). A provider who stays current with the literature should be willing to have this conversation.

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References

1. McAlindon TE, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain. JAMA, 2017;317(19):1967-1975.

2. Zeng C, et al. Intra-articular corticosteroids and the risk of knee osteoarthritis progression. JAMA, 2019.

3. Radiographic OA progression with corticosteroid injections. American Journal of Roentgenology, 2023.

4. RSNA imaging findings on corticosteroid effects in knee osteoarthritis, 2025-2026.

5. AAOS Clinical Practice Guidelines: Treatment of Osteoarthritis of the Knee.

6. Cleveland Clinic. Cortisone Shots: Steroid Injections. Cleveland Clinic

7. Comprehensive review of viscosupplementation. Orthopedic Reviews. Full Text

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Related Resources

• Cortisone Injection Risks: When Steroid Shots Backfire
• Study: Cortisone Shots May Worsen Knee Arthritis
• Why Doctors Are Moving Away From Cortisone
• Cortisone vs Gel Shots: Latest Evidence
• HA vs. Cortisone: Full Comparison
• Steroid Injections: How Often Is Safe?
• Best Knee Injection for Osteoarthritis
• Medicare Coverage for Gel Injections

This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your treatment plan.