How long do I have to wait to start stem cell treatment after a cortisone injection?

In this article, Ross Hauser, MD explains why cortisone and stem cells do not mix.

What does cortisone do to stem cells? For one thing, according to some researchers, cortisone prevents your stem cells from being able to heal tissue damage. So why then use cortisone in a joint that is trying to regenerate if the cortisone is compromising the repair process? We don’t know because in our practice cortisone/steroid injection and regenerative medicine do not mix.

We see many patients who have had a long and/or recent history of cortisone injections into damaged joints. Many of them become patients after they read this article on our site on options and alternatives to a cortisone injection.

The question they ask after reading about our treatments and the counterproductive healing characteristics of cortisone is: How long do I have to wait to start stem cell treatment after a cortisone injection?

We will suggest to patients in most instances that they wait at least one month, variables do apply, we may suggest a longer wait or a shorter wait depending on the patient’s unique situation. The reason to wait at all is explained in the research below.

This is the story of one patient who had a steroid injection for Bell’s palsy who also wanted a stem cell patch to repair a hole in their cartilage. Look at what happened to his stem cells.

An interesting observation study appeared in the American Journal of Sports Medicine in March of 2018. While testing the different types of stem cells that can be used to make a cartilage patch, Japanese and Canadian researchers made a significant observation in regards to the damage cortisone does to stem cells and how long it takes for the effects of cortisone to go away after injection into a damaged joint.

The way they came about this information was that the patient’s stem cells were examined at three and then 7 weeks after high dose steroid therapy for his Bell’s palsy condition.

Remember, the point of this study was to see if the researchers could make a stem cell patch to apply to holes in cartilage:

At three weeks after steroid therapy, the stem cells failed to generate a “tissue engineered construct, ” (the patch).
At seven weeks after steroid therapy, the stem cells were able to generate a “tissue engineered construct, ” (the patch).

What else could the researchers conclude but this:

Stem cells are compromised by high-dose steroid therapy – the immediate effects will eventually wear off. The long-term effects not so.

“This case suggests that mesenchymal stem cell (MSCs) are transiently compromised after high-dose steroid therapy and that careful consideration regarding timing of (stem cell) harvest is critical. “(1)

The fact that new research is pouring in on the detrimental effects of cortisone injections should not convince anyone that suddenly medicine is being alerted to the risk of corticosteroids. The dangers of cortisone injections have long been known. But in eagerness by health professionals and the patients themselves to get instant relief, the dangers were accepted as part of the treatment.

In 2009, I wrote in the Journal of Prolotherapy “It is my opinion that there is no doubt that the rise of osteoarthritis, as well as the number of hip and knee replacements, is a direct result of the injection of corticosteroids into these joints.”(2)

If you do not want to believe me, then let’s look at research from the Mayo Clinic published in 2015. The simple statement from this research is Cortisone threatens their innate regenerative capacity in exchange for temporary pain relief.(3)

Here is the long of what they are saying:

Mayo Clinic Research: Cortisone damages stem cells

Published in the journal: Clinical Orthopaedics and Related Research.

Studies have shown the deleterious / degenerative effects of corticosteroids on chondrocytes (cartilage building cells), suggesting cortisone contributes to degenerative joint disease.
Mesenchymal stem cells (MSCs) are the direct progenitors of chondrocytes and other musculoskeletal tissue. Additionally, they serve an important anti-inflammatory role, which can combat the chronic inflammatory state that mediates degenerative joint disease.

To test the theory that cortisone steroids damages stem cells. The researchers took stem cells from 20 patients who were scheduled to get a total hip replacement. They then exposed these people’s stem cells to different steroids for 60 minutes: Are these one of the steroids you are taking?

betamethasone sodium phosphate-betamethasone acetate (6 mg/mL),
dexamethasone sodium phosphate (4 mg/mL),
methylprednisolone (40 mg/mL), or
triamcinolone acetonide (40 mg/mL).

Conclusions:

Commonly used intraarticular corticosteroids had a dose-dependent, profound, and degenerative effect on the tested stem cells
- Betamethasone being the most toxic. Dexamethasone may result in less harmful effects.

For the reasons outlined about in the articles below, we do not combine steroids with H3 Prolotherapy, with Platelet Rich Plasma, or with stem cell therapy.

Please visit these articles on our website for a greater understanding of the damage cortisone does to your joints:

If you have questions about cortisone and stem cells or your own joint pain, get help and information from our Caring Medical Staff

1 Yasui Y, Hart DA, Sugita N, Chijimatsu R, Koizumi K, Ando W, Moriguchi Y, Shimomura K, Myoui A, Yoshikawa H, Nakamura N. Time-Dependent Recovery of Human Synovial Membrane Mesenchymal Stem Cell Function After High-Dose Steroid Therapy: Case Report and Laboratory Study. The American journal of sports medicine. 2018 Mar;46(3):695-701. [Google Scholar]

2 Hauser RA The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections Journal of Prolotherapy. 2009;1(2):107-123. [Journal of Prolotherapy]

3 Wyles CC, Houdek MT, Wyles SP, Wagner ER, Behfar A, Sierra RJ. Differential cytotoxicity of corticosteroids on human mesenchymal stem cells. Clinical Orthopaedics and Related Research®. 2015 Mar 1;473(3):1155-64. [Google Scholar]

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