Steroid Injections for Joint Pain: How Often Is Safe?

Key Takeaways

Corticosteroid injections can provide significant short-term relief from joint pain and inflammation
Benefits typically last 1-3 months, with wide individual variation
Most guidelines recommend limiting injections to 3-4 per year per joint
Repeated injections may accelerate cartilage loss in some patients
Injections work best when combined with other treatments (exercise, PT, weight management)
They’re a bridge treatment, not a long-term solution

Steroid injections—also called cortisone shots or corticosteroid injections—have been a mainstay of arthritis treatment for decades. They can provide welcome relief when other treatments aren’t enough. But how often can you safely receive them, and what are the long-term considerations?

This guide covers what you need to know about steroid injections for joint pain.

How Steroid Injections Work

The Mechanism

Corticosteroids are powerful anti-inflammatory medications. When injected directly into a joint:

They rapidly reduce inflammation
Decrease swelling and fluid accumulation
Reduce pain by calming irritated tissues
Allow improved joint function

What’s Injected

A typical joint injection contains:

Corticosteroid: Triamcinolone, methylprednisolone, or betamethasone
Local anesthetic: Lidocaine or similar (provides immediate pain relief, confirms correct placement)
Sometimes: Saline or other diluting fluid

Different from Anabolic Steroids

These are NOT the same as anabolic steroids used by athletes. Corticosteroids are anti-inflammatory medications with no muscle-building properties.

Benefits and Effectiveness

What to Expect

Immediate (from anesthetic):

Pain relief within minutes
Confirms injection reached the right spot
Wears off in a few hours

Delayed (from steroid):

Effects begin in 24-72 hours
Peak benefit usually at 1-2 weeks
Duration varies widely

Duration of Relief

Relief duration varies significantly:

Short responders: 2-4 weeks
Moderate responders: 1-3 months
Long responders: 3-6 months or longer
Non-responders: Minimal or no benefit

Factors Affecting Response

Better response likely with:

Significant inflammation present
Earlier stage arthritis
First injection (vs. repeat)
Combined with activity modification

Poorer response likely with:

Advanced bone-on-bone arthritis
Minimal inflammation (mechanical pain)
Previous injections with diminishing returns
Continued high-stress activities

Risks and Side Effects

Common Minor Effects

Post-injection flare: Temporary worsening of pain for 24-48 hours (5-10% of patients)
Facial flushing: Especially in women, may last days
Elevated blood sugar: Important for diabetics
Menstrual changes: Temporary
Skin lightening: At injection site (more visible in darker skin)
Fat atrophy: Thinning of tissue at injection site

Less Common but More Serious

Infection: Very rare with proper technique (less than 0.1%)
Tendon weakening: Avoid injecting into tendons
Systemic effects: Usually minor from single injection

The Cartilage Concern

Recent research has raised concerns about repeated injections:

What studies show:

Some studies found accelerated cartilage loss with repeated knee injections
A 2017 study showed more cartilage loss in patients receiving regular injections vs. saline
Effects may be dose and frequency dependent

Important context:

Not all studies show this effect
Advanced arthritis may progress regardless
Cartilage loss doesn’t always correlate with symptoms
The clinical significance is still being debated

Bottom line: There’s legitimate concern about overuse, supporting the recommendation to limit frequency.

How Often Is Safe?

Current Guidelines

Most medical organizations recommend:

Maximum: 3-4 injections per joint per year
Minimum interval: 3 months between injections
Lifetime consideration: Some suggest a limit of ~10 injections per joint over a lifetime

Why These Limits?

Diminishing returns:

Benefits often decrease with repeated injections
If not working well, unlikely to improve with more

Potential harm:

Possible cartilage effects with frequent injections
Cumulative risk of side effects
May mask worsening condition

Not addressing the cause:

Injections don’t change the underlying arthritis
Repeated injections suggest need for different approach

When to Reconsider

Think about changing your approach if:

Relief lasts less than 4-6 weeks
You’ve had more than 3 injections in a year
Benefits are decreasing with each injection
You’re relying solely on injections without other treatment

Making Injections Work Better

Combine with Other Treatments

Steroid injections work best as part of a comprehensive plan:

During the relief window:

Begin or intensify physical therapy
Start an exercise program
Work on weight loss if needed
Try other treatments that were too painful before

The goal: Use the pain relief period to make changes that provide longer-term benefit.

Optimize Timing

Consider injections when:

You have an important event or trip
Starting physical therapy
Pain is preventing necessary exercise
Other options have been tried

Not just because:

It’s been 3 months since last injection
You want to “stay ahead” of pain
It worked well before (may not again)

Alternatives to Consider

If Injections Are Losing Effectiveness

Other injection options:

Hyaluronic acid injections (different mechanism, may help when steroids don’t)
PRP (emerging, not proven but some find helpful)

Non-injection approaches:

More intensive physical therapy
Weight loss (if applicable)
Bracing or assistive devices
Different oral medications

Surgical options:

If conservative treatment fails
Joint replacement is highly effective for appropriate candidates
Learn about when knee replacement is necessary

Special Considerations

For Diabetics

Blood sugar will likely increase for 2-7 days
Monitor more frequently after injection
May need temporary insulin adjustment
Discuss with your endocrinologist or primary doctor

For Those on Blood Thinners

Injection is usually still possible
Increased bruising risk
Some doctors prefer to hold blood thinners briefly (discuss with prescribing doctor)
Pressure after injection for longer than usual

Before Joint Replacement Surgery

Most surgeons want 3 months between injection and surgery
Steroid in joint may increase infection risk with surgery
Plan ahead if surgery might be needed

Questions to Ask Your Doctor

How severe is my arthritis? Is an injection likely to help?
What other treatments should I be doing?
How many injections have I had, and where are we in terms of limits?
If this doesn’t work or stops working, what are our next options?
Are there reasons I should be particularly cautious?

Frequently Asked Questions

Why do some people get great relief while others don’t?

Response depends on many factors: the type and stage of arthritis, how much inflammation is present, individual variation in drug metabolism, and the accuracy of injection placement. People with significant inflammation often respond better than those with pure mechanical/structural problems.

Can I get injections in multiple joints at once?

Yes, but there are limits to total steroid dose per visit. Your doctor will determine what’s appropriate. Some spread out multiple joint injections over separate visits to limit systemic exposure.

How painful is the injection?

Most people describe it as brief, moderate discomfort—a sting when the needle enters and pressure as fluid is injected. The local anesthetic helps. Some joints (like knees) are easier to inject with less discomfort than others.

Can injections “fix” my arthritis?

No. Injections treat symptoms (pain and inflammation) but don’t change the underlying condition. The arthritis remains after the injection wears off. That’s why combining injections with other treatments is so important.

Should I rest after an injection?

Generally, take it easy for 1-2 days to let the steroid distribute in the joint and reduce the chance of flare. Avoid strenuous activity. After that, normal activity is encouraged—that’s the point of the injection.

Why can’t I just get injections whenever I want?

Because of potential negative effects on cartilage with frequent injections, diminishing returns, and the fact that repeated injections suggest a need for different approaches. The limits are there to protect your joint health.

Exploring other treatment options? Learn about hyaluronic acid injections or read about cortisone injection risks.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Discuss steroid injections and all treatment options with your healthcare provider.