multiple joint pain after steroid injections - AVN?

[ctts]

I have a patient for whom I do cervical ESIs and caudal ESIs when needed. She states that she has experienced multiple joint pain after a few of the injections, although not every time. Usually pain in hips, knees, ankles. Not severe. Onset shortly after the injection, and resolves by the next morning, and did not affect her sleep. The last time however, the pain was more severe, affected her sleep, to the extent she thought about going to ER. It did resolve by the next evening, but longer duration of pain compared to prior. The pain does resolve, but concerned that this could be a sign she is at risk for AVN or maybe already has some degree of AVN? I have not had any other patients tell me they experience joint pain like this after steroid injections. I did however have a patient in the past with multiple joint AVN (shoulders, hips, knees) that she attributed to multiple steroid injections done by another physician. Should I tell the patient that she should avoid steroids as much as possible? Should ESIs be considered contraindicated for her? Should I consider MRI of at least one of the affected joints (maybe hip) to see if there is any sign of early AVN?

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[au bon pain]

Doesn't fit.

AVN and subsequent pain from steroids takes months to set in:

Glucocorticoid-induced osteonecrosis

Awareness of the need for prevention of glucocorticoid- induced fractures is growing, but glucocorticoid administration is often overlooked as the most common cause of nontraumatic osteonecrosis. Glucocorticoid- induced osteonecrosis develops in 9–40% ...

www.ncbi.nlm.nih.gov

And sporadic short-term pain occurring around such isolated events where stress isn't being put on the joint(s)? Also doesn't sound like AVN.

 

[DrSpine]

Not AVN. Def doesn't sound like it and wouldn't occur like that.

 

[ctts]

I agree she probably does not have AVN now, but I guess what I was thinking is that perhaps there is some temporary microvascular compromise occurring in the joints, that may be a precursor to AVN or a sign that she is at risk of full blown AVN with repeated steroid exposure? I suppose this is speculation and I do not think there is quite anything in the literature to address this specific situation and timing. I know anyone could develop AVN, but if her symptoms are a warning sign, I would feel awful if I continue with injections and then she later develops AVN.

 

[Laryngospasm]

In theory steroids can cause vascular spasm and so some sort of ischemia related to this in the short term would not be out of the question.