DEAR READER: Cortisone can be injected into joints such as the ankle, knee, shoulder and other areas to relieve pain and inflammation. They have been known to help osteoarthritis, gout, carpal-tunnel syndrome, bursitis, plantar fasciitis and a host of other conditions. About 30 years ago, corticosteroids were given with great regularity. Today, however, a different approach is taken. Some physicians restrict a person to three injections a year, others to three in a lifetime. This has resulted from research indicating that repeated injections can cause damage to tissues over time when given in excess quantities to one area of the body. One consideration is whether or not the injections work. If one or two are unsuccessful for reducing pain, it’s rather unlikely that additional ones will respond any differently.

Side effects include a cortisone flare, in which the injected material crystallizes, causing pain for up to two days that could be greater than what was experienced prior to the injection. Tendons can be weakened, there can be pain at the injection site, and the color of the skin at the site can change. The most common systemic reaction is observed in diabetic patients, who should monitor their readings, because cortisone can cause a rise in blood-sugar levels. Long-term risks of high doses with frequent administration can include weight gain, facial puffiness, cataracts, osteoporosis, hypertension and rare but serious damage to the large joint bones, known as avascular necrosis.

So, in answer to your question, your mother should return to her orthopedic surgeon or the physician who gave her the injections. If that specialist (who is familiar with her medical history) feels strongly that no more should be administered, then I suggest you heed the warning. If, however, your mother is aging, her quality of life is affected, and she cannot find relief from pain through other means, perhaps she will receive a favorable response. The pros and cons can be answered only by the person behind the needle.

To provide related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title.

Would it hurt to try and do light exercise? Is it better to wait until the inflammation and pain go away? With proper treatment, how long do you think it will take to heal?

Would an MRI test on both shoulders help to determine how much inflammation is present and whether there are any muscle tears in the shoulder joints? I would appreciate any insight and information you can provide.

DEAR READER: Bursitis and tendinitis are common conditions that cause inflammation of the soft tissue around muscles and bones of the shoulders, elbows, hips, knees, ankles or wrists.

A bursa is a cushioning, fluid-filled sac located between bones, muscles, tendons or skin. Bursitis occurs when a bursa becomes inflamed. Bursitis is often caused by trauma or overuse.

A tendon is a flexible band of fibrous tissue that connects muscle to bone. Tendinitis is inflammation of a tendon that commonly occurs with the repetition of an act such as weightlifting, swinging a hammer, golfing, playing tennis or a musical instrument or other activities that place stress on joints.

There are two types of tendinitis that can affect the shoulder. Biceps tendinitis results in pain in the front or side of the shoulder. That pain may radiate to the elbow or forearm. Rotator-cuff tendinitis may result in shoulder pain at the upper outer arm and tip of the shoulder. Pain can be worsened by raising the arm above shoulder level or by lying on the affected side. Activity such as weightlifting can cause irritation to the bursa or rotator cuff and could lead to inflammation and impingement.

Diagnosis can be made through medical history and examination. Physicians and/or therapists might use manual testing known as selective tissue tension to determine which tendon is involved. X-rays might be helpful in ruling out problems with arthritis or bone but will not reveal tendons and bursae. Magnetic resonance imaging (MRI) should confirm or deny any tear and its extent. An anesthetic-injection test could also confirm the diagnosis of tendinitis. During this test, lidocaine hydrochloride is injected into the painful area. If the pain is relieved temporarily, the diagnosis is confirmed.

Treatment is directed toward healing the injured bursa or tendon.

Mild symptoms are commonly relieved with rest, elevation of the affected joint and over-the-counter medications such as ibuprofen or naproxen. Ice is often used following an initial injury for up to five days but isn’t generally helpful for chronic cases of either disorder. Corticosteroid injections may be given for control but should be used with caution because they can lead to weakening or rupture of tendons, primarily those that bear weight, such as the knees and ankles. In cases where bursitis is caused by infection, antibiotics will likely be ordered. Controlled, limited exercise or physical therapy can be performed prior to complete healing. When all else fails, surgery may be necessary.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Polymyalgia rheumatica (PMR) is an inflammatory disorder that results in widespread muscle aches, pains and stiffness of the hips, shoulders, thighs, upper arms and neck, fatigue, anemia, malaise and unintentional weight loss. Symptoms experienced are the result of mild inflammation of the joints and surrounding tissue. Stiffness can worsen following periods of inactivity, such as after a night’s sleep or sitting for too long.

The condition is thought to be related to an immune-system arthritic disorder that customarily goes away on its own in a year or two. Initially, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) might control the side effects. Long-term use of NSAIDs can include intestinal bleeding, hypertension, renal insufficiency, fluid retention and more. Beyond that, medication such as corticosteroids and self-help measures can go a long way toward dealing with the discomfort. The downside to long-term steroid use is possible hypertension, osteoporosis, diabetes, weight gain and cataracts.

Self-help includes a nutritious diet rich in fresh fruits and vegetables, lean meats, whole grains, calcium and vitamin D. The latter two recommendations can be satisfied through supplements. The daily recommendation for calcium in people over 50 is 1,200 milligrams per day with 600 to 800 international units (IU) of vitamin D. Exercise, primarily low-impact movement such as swimming, riding a stationary bicycle or walking, will go a long way toward reducing the pain.

Risk factors include age, race, gender and those diagnosed with giant cell arteritis. Older adults, primarily those 70 and older, are affected, and women are twice as likely as men to develop the disorder. No one is immune; however, Caucasians, Scandinavians and people from Northern Europe are most at risk. Finally, giant cell arteritis is a condition in which the temporal arteries and other areas of the body become swollen and inflamed. Almost 50 percent of all people diagnosed with giant cell arteritis are found to have polymyalgia, and up to 20 percent of those with polymyalgia develop giant cell arteritis.

Diagnosis can be made through laboratory testing that may include a rheumatoid factor, sedimentation rate, C-reactive protein, platelet and red-blood-cell counts. The only way to rule out giant cell arteritis is through biopsy from the scalp artery at the temple.

To provide related information, I am sending you copies of my Health Reports “Fibromyalgia” (a related topic) and “Managing Chronic Pain.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

I am white, in my late 50s and have multiple other problems — asthma, fibromyalgia, high blood pressure, rosacea, borderline high cholesterol, osteoarthritis and low oxygen at night that isn’t sleep apnea. I’ve had a detatched retina that is now a buckle and a cyst on the retina in my other eye. Thus, my doctor chooses to watch rather than treat at this stage.

Do you have other information that I might find useful?

DEAR READER: Sarcoidosis is an inflammatory disorder that can affect any organ in the body. It is marked by small, round bumps in the tissue around the affected organs to include the lungs, spleen, mucus membranes, salivary glands, lymph nodes and skin. Less common are the eyes and liver that can also be affected. The lesions can disappear after a period of months or years but can lead to widespread swelling and fibrosis.

Symptoms may include a persistent cough, weight loss, arthritic pain in the joints, shortness of breath and fatigue.

While the exact cause of the disease is unknown, it appears linked to the immune system overreacting to an unknown pathogen, toxin or drug that enters the body through inhaling. Genetic factors also play a role, as do race and age.

Our immune systems are structured to fight bacteria and viruses that enter the body, allowing us to remain healthy. With sarcoidosis patients, the white blood cells respond too strongly to bacteria and viruses, triggering small but specific areas of inflammation known as granulomas. With progression of the disease, those granulomas can damage healthy tissue and cause scarring.

Diagnosis can be made by visual examination of the lesions, enlarged lymph nodes and redness of the eyes. A chest X-ray will be abnormal, laboratory testing will likely reveal higher-than-normal blood-calcium levels, and pulmonary-function testing will reveal lung changes. Beyond that, there are numerous other tests available for confirmation, if necessary.

Some people do not need any treatment at all. When symptoms are present, treatment will vary depending on which organs are affected. Anti-inflammatory drugs known as corticosteroids are commonly prescribed. When a patient cannot tolerate steroid treatment, other options, such as methotrexate, azathioprine or hydroxychloroquine, may help.

While you may never recover completely, there are steps you can take to lessen symptoms. If your physician prescribes medication, be sure to take it according to the recommendations. Abstain completely from smoking, and avoid as many other irritants as possible, such as air pollution and dust. Last but not least, consider joining a support group. Your local chapter of the American Lung Association can assist you in finding a chapter nearby.

To provide related information, I am sending you a copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter. Forward it to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Without knowing more, I cannot be certain, but the first thing that comes to mind is angioedema. This is an inflammation of the tissues just under the skin. There are two types — hereditary and acquired. Hereditary angioedema (HAE) is rare and genetic. Acquired angioedema is much more common and often the result of an allergic reaction, and it typically affects the skin around the eyes and lips. I urge you to speak to your physician about this possibility.