Corticosteroid injections may lead to progression of knee OA
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Results presented at the Radiological Society of North America Annual Meeting showed corticosteroid injections may be associated with progression of knee osteoarthritis as assessed semi-quantitatively by whole-organ MRI scores.
“Our results further support limited use of corticosteroids and suggest benefits of hyaluronic acid, which appears to minimize progression of osteoarthritis, especially in patients for whom other noninvasive treatments, such as NSAIDs, are contradicted,” Upasana Upadhyay Bharadwaj, MD, a NIH T32 research scholar at the University of California, San Francisco, told Healio.
Upadhyay Bharadwaj and colleagues propensity-score matched patients from the Osteoarthritis Initiative cohort who received a single injection of corticosteroid, hyaluronic acid (HA) or who were in a control group.
“We assessed worsening of knee osteoarthritis using a comprehensive, whole-organ evaluation of standard knee MRI, which provides more detailed information than prior studies that use X-rays or isolated, quantitative measures from specialized MRI,” Upadhyay Bharadwaj said.
Researchers quantified progression of OA using the difference in whole-organ MRI scores between baseline and 2-year follow-up.
Results showed corticosteroid injection had a significant association with post-injection progression of whole-organ MRI scores during 2 years for the knee overall, lateral meniscus, lateral cartilage and medial cartilage. However, researchers noted HA injections had no significant association with post-injection progression of whole-organ MRI scores. Researchers also found no significant association between corticosteroid injections or HA injections with progression of pain quantified by the WOMAC during 2 years.
Upadhyay Bharadwaj said that although HA may slow down progression of knee OA and alleviate long-term effects while offering symptomatic relief, corticosteroid injections were found to be associated with significant worsening of knee OA during a 2-year period and should be administered with caution.
“It was not surprising that corticosteroids are associated with progression of OA. Although they have been shown to be beneficial in pain management, likely due to an anti-inflammatory effect, there have always been concerns around steroids being cytotoxic to articular cartilage in prior human and animal studies,” Upadhyay Bharadwaj said. “Though considered relatively safe short-term, the long-term effects on cartilage may lead to progression of osteoarthritis.”
Editor's note: On Dec. 15, 2022, data in the first, third, fifth and sixth paragraphs of this story and the source and caption text were corrected with updated information from the study abstract. The editors regret the error.
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