Cortisone's damage is extensive

A syringe of cortisone can quickly silence the screaming joints of an injured athlete. But big relief now risks infirmity in the future.

Long-term misuse of the man-made steroid can do damage throughout the body, leading to torn tendons, infections, dead bones in joints and high blood pressure -- often not for years.

Doctors did not realize the extent of the side effects until the past decade or so. Many sports specialists now say they give only two or three cortisone shots per year in a joint, and only if rest, ice and other pain relievers fail.

"Cortisone is one of the most powerful anti-inflammatories we can give to humans," said Dr. Michael Reilly, a Fort Lauderdale surgeon who was a team doctor to the U.S. Olympic swim team last year. "But it has a lot of baggage, and it just isn't worth it in a lot of instances."

Cortisone was introduced in 1949, a synthetic version of the hormone cortisol that is made out of cholesterol by the adrenal glands atop the kidneys.

The body could not survive without cortisol. It helps maintain blood pressure and kidney function and plays a part in injuries by regulating swelling and pain. During stress, cortisol boosts glucose to help the body cope.

Sports embraced cortisone as a way to delay the effects of injuries that sideline players. It suppresses antibodies and other defender cells that combat injury by causing swelling and pain. The shots can last for a few hours to a few weeks.

Some dangers of cortisone were obvious, Reilly said. By masking injuries, players go full bore and may get hurt worse. Also, reducing antibodies risks infection in the injured area.

Later studies found more problems. Repeated cortisone shots can weaken "crosslinks," chemicals that bind the parallel fibers in a tendon, making the tendon more likely to rupture, Reilly said.

Cholesterol-based cortisone also leaves fatty deposits in blood vessels. In areas with tight circulation, such as the ball joints of the hip and shoulder, reduced blood flow can kill the bone and force the need to implant artificial joints.

"I've done ex-pro football players with deformed knees so bad they lost both of them way prematurely," Reilly said. "Judicious use of cortisone is crucial."

Originally published in the South Florida Sun-Sentinel