# What to know before choosing cortisone or PRP *Steroid or Biologic Injections Surprise — What to Expect* > Biologic injections Surprise compared with cortisone in plain words, including timing, repeat use, soreness and questions for your visit. If quick relief matters, say so at the first visit. Cortisone often starts working sooner. Platelet-rich plasma (PRP) starts as your blood, which the office spins to collect platelets, the small parts that help stop bleeding. PRP takes longer to judge, and it doesn't help everyone. Tell the doctor which task you want to do more easily. Relief for next week's chores isn't the same as relief over several months. ## How long do cortisone shots last Cortisone can calm soreness for a while. Some people feel relief within days. Others feel little change. The relief can fade over the next several weeks. Think of cortisone as a pause button, not a repair. The catch is repeat use. Skin near the shot can thin or lose color. Blood sugar can rise for a short time. This matters when you have diabetes. Some research found more loss of knee cartilage after repeated shots. Other research didn't find that harm. Ask how long to wait before another shot. You'll also want to know when repeat shots should stop. Don't judge the result during the first few hours. ## What to know about cortisone shot side effects The joint can feel more sore just after cortisone. The skin may become lighter or thinner near the shot. Loss of fat under the skin can leave a small dent. Your face may feel warm and look red for a while. Tell the doctor if you take blood thinners. Also mention diabetes, past reactions and any recent infection. Don't stop a prescription on your own. Ask the doctor who ordered it first. Call promptly for fever with a hot or swollen joint. Spreading redness also needs a quick call. Before leaving, ask which other changes need care that day. ## What to ask before trying PRP Concentrated PRP has more platelets in its liquid than ordinary blood. More platelets alone don't prove the shot will work better. Some offices keep more white blood cells in the shot. That can mean more early soreness and swelling, without better relief. Ask how many visits the office expects. Find out what your joint may feel like afterward. Ask when the office will check whether daily tasks are easier. You'll then know how the result will be judged. QC Kinetix medical providers examine joints and offer biologic therapies, the clinic term for blood-based shots prepared there. ## Sources 1. The 2015 Cochrane review of 27 trials (1,767 participants) found intra-articular corticosteroid better than sham for knee OA pain (SMD -0.40, 95% CI -0.58 to -0.22; NNTB 8), but the benefit decayed with time: moderate at 1-2 weeks, small at 13 weeks, and no evidence of any effect at 26 weeks. All outcomes were graded LOW quality. Jüni P, et al. — [Intra-articular corticosteroid for knee osteoarthritis.](https://pubmed.ncbi.nlm.nih.gov/26490760/). *Cochrane Database Syst Rev*, 2015. DOI: 10.1002/14651858.CD005328.pub3. 2. In a 2-year double-blind RCT of 140 patients with symptomatic knee OA and ultrasound synovitis, 40 mg intra-articular triamcinolone every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with no significant difference in knee pain. McAlindon TE, et al. — [Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.](https://pubmed.ncbi.nlm.nih.gov/28510679/). *JAMA*, 2017. DOI: 10.1001/jama.2017.5283. 3. A network meta-analysis of 43 trials (5,554 patients) reached the OPPOSITE ranking to several PRP-favourable reviews: steroids ranked most likely to be effective for pain and function, with adipose MSC and multiple PRP injections ranked least likely, and steroids and hyaluronic acid showed lower adverse-event rates than placebo. Han SB, et al. — [Intra-Articular Injections of Hyaluronic Acid or Steroids Associated With Better Outcomes Than Platelet-Rich Plasma, Adipose Mesenchymal Stromal Cells, or Placebo in Knee Osteoarthritis: A Network Meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/32305424/). *Arthroscopy*, 2021. DOI: 10.1016/j.arthro.2020.03.041. 4. In the Osteoarthritis Initiative cohort (684 propensity-matched participants), knees whose owners started intra-articular corticosteroids had radiographic OA worsening at 21.7 per 100 person-years versus 7.1 in comparators; the hazard ratio for Kellgren-Lawrence worsening was 3.02 for initiation, higher still for continuous use. Zeng C, et al. — [Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative.](https://pubmed.ncbi.nlm.nih.gov/30703543/). *Osteoarthritis Cartilage*, 2019. DOI: 10.1016/j.joca.2019.01.007. 5. A meta-analysis of 8 trials (648 patients, judged at low risk of bias overall) comparing intra-articular PRP with intra-articular corticosteroid found PRP significantly better for pain, stiffness and function at 3, 6 and 9 months (P<0.01), with the largest effects at 6 months (SMD -0.78) and 9 months (SMD -1.63). Three PRP injections a week apart outperformed a single injection over 12 months. McLarnon M, Heron N. — [Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/34134679/). *BMC Musculoskeletal Disorders*, 2021. DOI: 10.1186/s12891-021-04308-3. 6. A frequentist network meta-analysis with a minimum 6-month follow-up found all intra-articular treatments EXCEPT corticosteroid significantly better than placebo. PRP had the highest probability of efficacy for pain, function and both combined, followed by plasma rich in growth factors (PRGF), then HA, then corticosteroid, then placebo. Singh H, et al. — [Relative Efficacy of Intra-articular Injections in the Treatment of Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/34403285/). *American Journal of Sports Medicine*, 2022. DOI: 10.1177/03635465211029659. 7. RESTORE, the largest and most rigorously blinded placebo-controlled PRP trial in knee OA (n=288, participant-, injector- and assessor-blinded), gave three weekly injections of a commercial leukocyte-poor PRP or saline. At 12 months the change in knee pain was -2.1 vs -1.8 points (difference -0.4; 95% CI -0.9 to 0.2; P=.17) and the change in medial tibial cartilage volume was -1.4% vs -1.2% (difference -0.2%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no between-group difference. The authors concluded the findings do not support the use of PRP for knee OA. Bennell KL, et al. — [Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.](https://pubmed.ncbi.nlm.nih.gov/34812863/). *JAMA*, 2021. DOI: 10.1001/jama.2021.19415. 8. A meta-analysis of 34 RCTs (1,403 PRP knees vs 1,426 controls) found WOMAC favoured PRP over placebo at 12 months and over hyaluronic acid at 6 and 12 months, and favoured PRP over steroids on VAS pain, KOOS pain, daily function and quality of life at 6 months. Crucially, the authors state that the superiority of PRP DID NOT REACH the minimal clinically important difference for any outcome and the quality of evidence was low. Filardo G, et al. — [PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials.](https://pubmed.ncbi.nlm.nih.gov/32551947/). *Cartilage*, 2021. DOI: 10.1177/1947603520931170. 9. A meta-analysis of 11 RCTs (730 patients) with lateral epicondylitis found the timing reverses the answer: corticosteroid was significantly BETTER than PRP in the short term (under 2 months: VAS mean difference 0.93 favouring steroid; DASH 10.23 favouring steroid), the two did not differ at 2-6 months, and PRP was significantly better at 6 months or more (VAS -2.18; DASH -8.13; Mayo Elbow +16.53). Xu Y, et al. — [Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.](https://pubmed.ncbi.nlm.nih.gov/38357713/). *American Journal of Sports Medicine*, 2024. DOI: 10.1177/03635465231213087. 10. A meta-analysis of 27 RCTs (1,779 patients) across rotator cuff injury, lateral epicondylitis, plantar fasciitis and tenosynovitis found no PRP advantage at one month anywhere, and in some tendons corticosteroid was better early; PRP overtook corticosteroid at 3 months for rotator cuff VAS and at 6 months for plantar fasciitis VAS and AOFAS and for tenosynovitis VAS. Ye Z, et al. — [Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/40200209/). *BMC Musculoskeletal Disorders*, 2025. DOI: 10.1186/s12891-025-08566-3. 11. A meta-analysis of 24 RCTs (1,653 participants) with plantar fasciitis found PRP produced significantly better VAS pain than corticosteroid at 3 and 6 months but not at 1 month or 12 months, and better AOFAS function scores at 3, 6 and 12 months. Plantar fascia thickness did not differ significantly at any time point. Zuo A, et al. — [Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/39778212/). *American Journal of Physical Medicine & Rehabilitation*, 2025. DOI: 10.1097/PHM.0000000000002677. 12. FDA states verbatim of stem cell products, stromal vascular fraction (adipose-derived cells), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products. U.S. Food and Drug Administration — [Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes](https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes). *FDA (Center for Biologics Evaluation and Research)*, 2020. ## What to bring to the first visit Bring your medicine list, earlier X-rays and notes about the motion that hurts. Note when the soreness began. You'll also want one daily task you hope to make easier. Book a free consultation: --- Clear help for joint soreness. Get plain help for a sore joint, simple home care and signs that mean it's time for a clinic visit. Plain help for Surprise residents who want relief from a sore joint without surgery. This site is operated by the owners of the QC Kinetix Phoenix-area clinics; the business can benefit when readers schedule a consultation. © 2026 Surprise Joint Decision Desk. General education only; not medical advice or a diagnosis.