Corticosteroid injections do not worsen knee OA progression, expedite knee replacement
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Use of corticosteroid injections did not exacerbate radiographic progression of knee osteoarthritis or accelerate total knee replacement compared with hyaluronic acid, according to data presented at ACR Convergence 2020.
“There are not many widely available options for moderate-to-severe OA and the definitive treatment — joint replacement — is not an option for many patients,” Justin J. Bucci, MD, assistant professor of medicine at Boston University School of Medicine, said during a press conference. “Cortisone injections have been used for a long time to treat pain from knee OA, it provides short-term pain relief and is generally considered to be a safe procedure. [However] recent studies have questioned whether cortisone injections actually worsen knee OA.”
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“Our group was worried that it may be impossible to compare patients who get injections and those who don’t because there is something fundamentally different about these two groups,” he said. “We thought it would be interesting to compare cortisone injections with another type of injection that has not been associated with worsening knee OA: Hyaluronic acid, a component of healthy cartilage that can be injected into the knee to treat the pain from moderate-to-severe knee OA.”
To evaluate whether the use of cortisone injections were linked to increased rates of knee OA progression, Bucci and colleagues examined data from the Multicenter Osteoarthritis (MOST) and Osteoarthritis Initiative (OAI), focusing on patients who received either cortisone (n= 647) or hyaluronic acid (n=145) injections.
Patients receiving cortisone injections had medical exams every 12 months, and those receiving hyaluronic acid injections had exams every 30 months, which included knee X-rays and questions about their injections over the previous 6 months.
The researchers compared X-rays from each patient’s medical visits prior to their first injection with those taken following their last injection; Kellen and Lawrence scores and joint space narrowing scores were assigned to each X-ray at medical visits in which total knee replacement surgery was prescribed. Patients with a baseline Kellen and Lawrence score of 4 or had received corticosteroid or hyaluronic acid injections in the past were excluded.
According to study results, the rate of total knee replacement surgery was greater among patients with a single exam who reported hyaluronic acid injection vs. those with a single exam who reported corticosteroid injection (P = .04). However, no difference was found between patients reporting injections at multiple exams.
“We found that there was no difference in progression of knee arthritis between the two groups,” Bucco said. “Neither group had a significantly different rate of receiving knee replacement.”
Additionally, multivariable analysis demonstrated comparable rates of radiographic progression between patients who reported receiving corticosteroid and hyaluronic acid injections at single or multiple exams.
“Looking at these data, I think we can provide some reassurance to patients and clinicians treating knee OA that cortisone injections are not causing knee OA to get worse,” Bucci said. “Patients with moderate-to-severe knee OA that are not responding to conservative measures should still be offered cortisone injections, and patients who are getting benefit from these injections can still continue getting them without being worried about doing harm to their knees.”
He added: “Moving forward, we are looking at MRI data for this same question. We will look to see if there are any differences between knees treated with cortisone or hyaluronic injections and, hopefully, will reproduce findings from this study and provide additional reassurance to patients with knee OA.”
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Bucci JJ. Abstract #1652. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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