DEAR DR. GOTT: I am 71 years old and have arthritis really bad. Both shoulders and my hip and knee on the right side are all bone on bone. The orthopedic doctor I see about my neck said he doesn’t know what to do with it but surgery is out of the question on all of them.
Kenalog does help. My question is, how many shots can one have at one time and how often can they be given? Safely, of course.
DEAR READER: There are more than 100 different types of arthritis. Cartilage normally protects our joints and absorbs shock when pressure is exerted, such as during walking or other exercise. When a person has arthritis, that cartilage breaks down and pain, stiffness, inflammation and stiffness result. This may be from wear and tear on the joints, trauma such as a bone fracture, infection from bacteria or a virus, or from an autoimmune disease where the body’s immune system incorrectly attacks healthy tissue.
Kenalog-40 injections are synthetic corticosteroids with anti-inflammatory properties. The formula is reported to be for intramuscular and intra-articular (within a joint) use only. They are not intended for use within the layers of skin. These injections last for a period of several weeks, with initial results occurring within one to two days.
Dosing requirements and frequency remain variable and must be individualized for each patient. As a general rule, 60 mg is injected into the buttock muscle. The dosage is then adjusted to between 40 and 80 mg, depending on how the patient responds to the medication and the amount of relief experienced. Some patients are able to experience relief on 20 mg or even less. In any event, once a favorable response is noted, the initial dosage can be decreased minimally at appropriate time intervals until the lowest maintenance dosage possible is reached. This is done for the well-being of the patient’s long-term treatment. Once discontinuation is ordered under the direction of the prescribing physician, the process will be gradual, rather than abrupt. Injections should not be discontinued abruptly or without medical supervision and anyone on a corticosteroid should avoid exposure to individuals with chicken pox or measles. Immunizations should not be received while on Kenalog unless they are approved by your physician.
Small amounts of cortisone injections in the body are probably reasonable to consider but repeated injections can result in tissue damage over time. Unfortunately, there doesn’t appear to be any concrete rule as to how many can be given over a specific period of time. Your physician can direct you, depending on the amount of relief experienced, your overall health, medical history, and a number of other considerations. Therefore, I cannot specifically answer your question.
Drug interactions may occur if a patient is on specific antibiotics, oral anticoagulants, medication for diabetes, estrogen to include oral contraceptives, non-steroidal anti-inflammatory drugs (NSAIDs) and a number of other products, as well. Therefore, be sure to advise your physician of ANY and ALL prescribed medications and over-the-counter products that may have an impact on the performance of synthetic corticosteroids.
If side effects of Kenalog injections occur, they can include bone pain, severe stomach/abdominal pain, ankle and foot edema, weight gain, slow wound healing, painful urination, easy bruising, tarry stools, and more. Serious side effects are unlikely.
Readers who would like related information can order my Health Report “Osteoarthritis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
