Table of ContentsView AllTable of ContentsWhy Flares OccurSide EffectsRecoveryTreatmentDurationOsteoarthritis Management
Table of ContentsView All
View All
Table of Contents
Why Flares Occur
Side Effects
Recovery
Treatment
Duration
Osteoarthritis Management
But not everyone has a good experience. Some people have a reaction to acortisoneshot called a flare, sometimes called a “steroid flair.” Usually, the cortisone flare occurs within 24 to 48 hours of the shot and causes pain or inflammation around the injection site.
This article looks at why cortisone flares happen and how you can deal with the discomfort.
Verywell / Emily Roberts
Are Cortisone Injections Bad for You?
What Causes a Cortisone Flare?
Cortisone flares happen when cortisone crystallizes around the injection area.Cortisone can form crystals in the body—that way it can have a longer pain-relieving effect at the injection site.However, these crystals can attract immune system cells called macrophages. The flare, including symptoms such as pain and swelling, is an immune response.
You may also feel like your symptoms are worse once the numbing agent used with the injection wears off—but before the cortisone takes effect.
What Are the Side Effects of a Cortisone Shot?
Your healthcare provider will likely inject a local anesthetic with the corticosteroid to quickly numb the pain. The numbing agent will last for a few hours, and you may feel like your symptoms are worse once it wears off. The cortisone itself typically starts improving your symptoms after 5–7 days.
You may experience light swelling and redness around the place where you got the injection—applying ice can help. If you experience the following symptoms, and they get worse over time, make sure to contact a healthcare provider:
Between 1–10% of people who receive a cortisone shot have an increase in pain in the area being treated, which generally goes away within 48 hours.This is the “cortisone flare.”
Problems with cortisone shots can range from mild to quite serious. For example,hemarthrosis(bleeding into the joint) can occur, especially if you are taking blood thinners for another condition. Be sure to tell your healthcare provider before a cortisone shot if you are taking these kinds of drugs.
Other side effects may include:
How to Recover From a Cortisone Shot
The injection won’t take long, but you may need to adjust your behaviors for some time after:
The effect of the cortisone will likely start after five to seven days. Most people eventually feel less pain or no pain at all.
How is a Cortisone Flare Treated?
The best treatments for a cortisone flare are:
If pain, redness, fever, or swelling begin several days or weeks after the shot, this is not a cortisone flare reaction. Call your healthcare provider, especially if you have a fever with these symptoms.
How Long Do Cortisone Flares Last?
Cortisone flare reactions are almost always brief, and typically will begin to ease within a few hours or days. That’s especially likely as the cortisone begins to work on the inflammation.
If your symptoms get worse despite ice and over-the-counter pain relief, make sure to call your healthcare provider. Your healthcare provider can help to diagnose the reason.
How to Manage Osteoarthritis
If you experience osteoarthritis pain, there are different treatment options you can try as alternatives to cortisone shots. Non-medication approaches include:
Non-steroidal anti-inflammatory drugs (NSAIDs)—such as Advil (ibuprofen) or Aleve (naproxen)—are typically the first recommended pain relievers. NSAIDs can come in oral pill or topical cream form.Talk to your healthcare provider before taking NSAID medications regularly, even if you use over-the-counter NSAIDs.
Summary
In most cases, the discomfort from a flare reaction is treated with rest, ice, and over-the-counter medication. If pain and other symptoms don’t go away in a day or two, or get even worse, call your healthcare provider.
How Long Does It Take for a Steroid Shot to Work?
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shah A, Mak D, Davies AM, James SL, Botchu R.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi:10.1016/j.carj.2018.11.002Alsop RJ, Khondker A, Hub JS, Rheinstädter MC.The lipid bilayer provides a site for cortisone crystallization at high cortisone concentrations.Sci Rep. 2016;6:22425. Published 2016 Mar 3. doi:10.1038/srep22425MedlinePlus.Steroid injections - tendon, bursa, joint.Waterbrook AL, Balcik BJ, Goshinska AJ.Blood glucose levels after local musculoskeletal steroid injections in patients with diabetes mellitus: A clinical review.Sports Health. 2017;9(4):372-374. doi:10.1177/1941738117702585National Health Service.Side effects of hydrocortisone injections.Johns Hopkins Medicine.Injectable corticosteroids.National Health Service.How and when to have hydrocortisone injections.Yu SP, Hunter DJ.Managing osteoarthritis.Aust Prescr. 2015;38(4):115-119. doi:10.18773/austprescr.2015.039National Health Service.Common questions about hydrocortisone injections.Additional ReadingArthritis Foundation.Corticosteroids.Brook EM, Hu CH, Kingston KA, et al.Corticosteroid injections: a review of sex-related side effects.Orthopedics. 2017;40(2). doi; 10.3928/01477447-20161116-07Deyle GD, Allen CS, Allison SC, et al.Physical therapy versus glucocorticoid injection for osteoarthritis of the knee.N Engl J Med. 2020;382(15):1420-1429. doi:10.1056/NEJMoa1905877
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shah A, Mak D, Davies AM, James SL, Botchu R.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi:10.1016/j.carj.2018.11.002Alsop RJ, Khondker A, Hub JS, Rheinstädter MC.The lipid bilayer provides a site for cortisone crystallization at high cortisone concentrations.Sci Rep. 2016;6:22425. Published 2016 Mar 3. doi:10.1038/srep22425MedlinePlus.Steroid injections - tendon, bursa, joint.Waterbrook AL, Balcik BJ, Goshinska AJ.Blood glucose levels after local musculoskeletal steroid injections in patients with diabetes mellitus: A clinical review.Sports Health. 2017;9(4):372-374. doi:10.1177/1941738117702585National Health Service.Side effects of hydrocortisone injections.Johns Hopkins Medicine.Injectable corticosteroids.National Health Service.How and when to have hydrocortisone injections.Yu SP, Hunter DJ.Managing osteoarthritis.Aust Prescr. 2015;38(4):115-119. doi:10.18773/austprescr.2015.039National Health Service.Common questions about hydrocortisone injections.Additional ReadingArthritis Foundation.Corticosteroids.Brook EM, Hu CH, Kingston KA, et al.Corticosteroid injections: a review of sex-related side effects.Orthopedics. 2017;40(2). doi; 10.3928/01477447-20161116-07Deyle GD, Allen CS, Allison SC, et al.Physical therapy versus glucocorticoid injection for osteoarthritis of the knee.N Engl J Med. 2020;382(15):1420-1429. doi:10.1056/NEJMoa1905877
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Shah A, Mak D, Davies AM, James SL, Botchu R.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi:10.1016/j.carj.2018.11.002Alsop RJ, Khondker A, Hub JS, Rheinstädter MC.The lipid bilayer provides a site for cortisone crystallization at high cortisone concentrations.Sci Rep. 2016;6:22425. Published 2016 Mar 3. doi:10.1038/srep22425MedlinePlus.Steroid injections - tendon, bursa, joint.Waterbrook AL, Balcik BJ, Goshinska AJ.Blood glucose levels after local musculoskeletal steroid injections in patients with diabetes mellitus: A clinical review.Sports Health. 2017;9(4):372-374. doi:10.1177/1941738117702585National Health Service.Side effects of hydrocortisone injections.Johns Hopkins Medicine.Injectable corticosteroids.National Health Service.How and when to have hydrocortisone injections.Yu SP, Hunter DJ.Managing osteoarthritis.Aust Prescr. 2015;38(4):115-119. doi:10.18773/austprescr.2015.039National Health Service.Common questions about hydrocortisone injections.
Shah A, Mak D, Davies AM, James SL, Botchu R.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi:10.1016/j.carj.2018.11.002
Alsop RJ, Khondker A, Hub JS, Rheinstädter MC.The lipid bilayer provides a site for cortisone crystallization at high cortisone concentrations.Sci Rep. 2016;6:22425. Published 2016 Mar 3. doi:10.1038/srep22425
MedlinePlus.Steroid injections - tendon, bursa, joint.
Waterbrook AL, Balcik BJ, Goshinska AJ.Blood glucose levels after local musculoskeletal steroid injections in patients with diabetes mellitus: A clinical review.Sports Health. 2017;9(4):372-374. doi:10.1177/1941738117702585
National Health Service.Side effects of hydrocortisone injections.
Johns Hopkins Medicine.Injectable corticosteroids.
National Health Service.How and when to have hydrocortisone injections.
Yu SP, Hunter DJ.Managing osteoarthritis.Aust Prescr. 2015;38(4):115-119. doi:10.18773/austprescr.2015.039
National Health Service.Common questions about hydrocortisone injections.
Arthritis Foundation.Corticosteroids.Brook EM, Hu CH, Kingston KA, et al.Corticosteroid injections: a review of sex-related side effects.Orthopedics. 2017;40(2). doi; 10.3928/01477447-20161116-07Deyle GD, Allen CS, Allison SC, et al.Physical therapy versus glucocorticoid injection for osteoarthritis of the knee.N Engl J Med. 2020;382(15):1420-1429. doi:10.1056/NEJMoa1905877
Arthritis Foundation.Corticosteroids.
Brook EM, Hu CH, Kingston KA, et al.Corticosteroid injections: a review of sex-related side effects.Orthopedics. 2017;40(2). doi; 10.3928/01477447-20161116-07
Deyle GD, Allen CS, Allison SC, et al.Physical therapy versus glucocorticoid injection for osteoarthritis of the knee.N Engl J Med. 2020;382(15):1420-1429. doi:10.1056/NEJMoa1905877
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