Question

I’m having a lot of joint problems at the moment and my consultant wants to inject a steroid into the joint to reduce the inflammation and pain. I’m concerned that this could make my ME worse because I thought that people with ME shouldn’t be given steroids.

Answer

Firstly, it’s worth noting that the use of a steroid injection, or a course of steroid injections, can be a very effective way of treating some types of joint problem. The amount of steroid that is used is normally much less that would, for example, be used for treating an exacerbation of asthma.

Secondly, the use of steroids – by mouth or by injection – is not contra-indicated in ME/CFS. In fact, low doses of hydrocortisone have been assessed as a possible form of treatment for ME/CFS in some small clinical trials. This is because mild hypocortisolaemia (= a slightly lowered level of cortisol in blood) is a consistently reported research finding in ME/CFS.

Steroids do, of course, have a number of potential side-effects. These are unlikely with injections although a flare-up of joint pain within the first 24 hours after the injection does occasionally occur. This usually settles down on its own within a couple of days. Taking simple painkillers such as paracetamol will help. Injections can temporarily improve pain in other joints, particularly those close to the injection site.

The risk of side-effects is greatest with the stronger injection mixtures. The mildest mixture is hydrocortisone. Methylprednisolone and triamcinolone are stronger and tend to be dissolve less easily – so they stay in the joint for longer and are more likely to cause side-effects.

Local steroid injections sometimes cause facial flushing. Other steroid-related side-effects are rare unless you have frequent injections (i.e more than a few times per year).

Oral steroids, especially when given at high doses or over a long period of time can produce more serious side-effects – including osteoporosis, diabetes, high blood pressure, or changes in mood. They can also cause weight gain, muscle weakness and lower the body’s resistance to infection – all of which are relevant if you have ME/CFS.

So if you already have any of these conditions, this will have to be taken into consideration if long-term or high-dose steroid treatment is being considered.

Research into hypocortisolaemia, and a summary of clinical trials which have assessed the use of hydrocortisone in ME/CFS, can be found in the research and treatment section of the MEA ME/CFS/PVFS Clinical & Research Guide 2022 Edition (also known as the ‘purple book')

See Also: Treatment: Low Dose Steroids, Treatment: High-dose Steroids

More Information:

• The charity, Versus Arthritis, has useful information on steroid injections