Intra-articular steroid injections are a well recognised treatment for rheumatoid arthritis and osteoarthritis with an inflammatory component. It is also clear that the effects of intra-articular steroid treatment are not confined to the joint injected. Steroid is absorbed, inducing improvement in the indices of general inflammation and a clinical1 and thermographic improvement in other joints.2 ,3 Peak serum steroid levels occur from two to 12 hours after injection, and the drug is completely cleared within three to five days. However, cortisol levels are suppressed by 64–81% at 24 hours after injection, with most patients' values returning to normal by one week; depo-medrone (methylprednisolone acetate) 40 mg is sufficient to induce maximum suppression.4 Many complications are known to arise after systemic steroid administration, but we are …