Joint pain, particularly that caused by osteoarthritis, often requires non-surgical interventions to manage discomfort and maintain mobility. When conservative treatments like physical therapy and over-the-counter medication are insufficient, physicians frequently turn to intra-articular injections. Two common types are the cortisone shot and the “gel injection,” which differ significantly in their mechanism of action and therapeutic goals.
Defining the Purpose of Each Injection
A cortisone shot, or corticosteroid injection, is designed to reduce inflammation rapidly. The medication mimics cortisol, a naturally occurring hormone, to suppress the immune response directly within the joint space. This powerful anti-inflammatory effect provides quick relief from pain and swelling, often within a few days. Cortisone shots are best suited for addressing acute inflammatory flare-ups.
In contrast, a gel injection, or viscosupplementation, uses hyaluronic acid (HA), a natural component of healthy joint fluid. Osteoarthritis causes the natural HA to thin, reducing its ability to lubricate and absorb shock. Injecting HA restores the fluid’s viscosity, improving the joint’s mechanical function over time. The effects of viscosupplementation are delayed, taking several weeks to become noticeable, but relief may last for many months.
Sequencing Cortisone After a Gel Injection
A cortisone shot can generally be administered after a gel injection, and this sequence is a common clinical practice. The two treatments address different aspects of joint pathology, making their sequential use a logical strategy. Viscosupplementation is the long-term treatment aimed at improving the joint’s environment and function.
The cortisone shot serves as a “rescue” therapy for acute inflammatory flare-ups that occur after the gel injection. It can also be used to provide immediate pain relief while the patient waits for the slower-acting hyaluronic acid to take effect. This dual-action approach ensures prompt symptom relief while initiating a longer-term strategy for joint health. The decision to administer the corticosteroid depends on the patient’s ongoing symptoms and response to the initial gel injection.
Safety Protocols and Waiting Periods
While using both injections sequentially is permissible, physicians must consider the timing to maximize benefit and minimize risk. There is no absolute rule against administering a cortisone shot soon after a gel injection, especially in cases of severe pain. However, many doctors prefer to wait a few weeks to a month after the HA injection to accurately gauge its effectiveness. Waiting allows the physician to determine if the long-term treatment plan is working as intended.
The main safety concern relates to the risk of repeatedly puncturing the joint capsule, which carries a risk of infection or bleeding with each injection. While a single cortisone injection after HA is acceptable, repeated corticosteroid injections into the same joint are discouraged. Excessive cortisone use can accelerate the deterioration of cartilage, counteracting the joint-protecting goal of the gel injection. The final decision regarding the timing and necessity of a subsequent cortisone shot must be made by a physician.