Corticosteroid Injections Might Accelerate Arthritis Progression - medtigo



Corticosteroid Injections Might Accelerate Arthritis Progression

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Osteoarthritis is a degenerative joint disease that causes pain, stiffness, and mobility difficulties. This illness is most commonly characterized by pain and stiffness in the hands, knees, hips, and spine. People with higher BMIs, older age, and a history of joint disease are more likely to develop osteoarthritis.

According to ScitechDaily, two recent studies have linked the use of corticosteroid injections, which are often used to relieve the pain of knee osteoarthritis, to faster development of the illness. These findings were recently reported at the Radiological Society of North America’s annual meeting (RSNA).  

Osteoarthritis is the degradation of joint cartilage and affects 32.5 million people in the United States. Knee osteoarthritis affects around 800,000 people in the United States each year. This ailment worsens with time, making it more challenging to move around and tolerate discomfort. As a noninvasive therapy option, around 10% of patients with knee osteoarthritis chose injectable corticosteroid or hyaluronic acid.  

Both studies used cohorts from the Osteoarthritis Initiative, a multi-center, longitudinal observational research of almost 5,000 persons with knee osteoarthritis in its 14th year of follow-up. The initial research at the University of California, San Francisco, had 210 patients from the Osteoarthritis Initiative over two years; 70 got intra-articular injections, while the remaining 140 did not.

Half of the 70 patients got hyaluronic acid injections, while the other half got corticosteroid injections. Age, gender, BMI, pain, exercise, and illness intensity were all comparable across the treatment and control groups.  

All patients had magnetic resonance imaging at the time of the injection and again two years later. The whole-organ magnetic resonance imaging score (WORMS) was used to analyze the MRI scans of individuals with knee osteoarthritis, prioritizing the meniscus, bone marrow lesions, cartilage, joint effusion, and ligaments.

By comparing imaging scores from baseline and follow-up scans conducted two years apart, the researchers could pinpoint the development of osteoarthritis. Upasana Upadhyay Bharadwaj, M.D., a research fellow in the Department of Radiology at the University of California, San Francisco, asserts that “this is the first direct comparison of corticosteroid and hyaluronic acid injections utilizing semi-quantitative, whole organ evaluation of the knee with MRI.

“Prior corticosteroid injections into the knee were found to be statistically related to knee osteoarthritis, especially lateral meniscus, lateral cartilage, and medial meniscus osteoarthritis.  

Injections of hyaluronic acid into the knee did not appear to slow the course of osteoarthritis. As evidenced by bone marrow lesions, osteoarthritis proceeded more slowly in the hyaluronic injection group than in the control group. Injections of corticosteroids and hyaluronic acid are advised to relieve knee osteoarthritis pain.

Data, however, show that corticosteroids, even when used with caution, are associated with a significant acceleration of knee osteoarthritis for up to two years following injection. In contrast, hyaluronic acid may decrease the progression of knee osteoarthritis and reduce long-term consequences while providing symptomatic relief.  


The second study, a case-control study undertaken by researchers at Rosalind Franklin University of Medicine and Science’s Chicago Medical School, looked at the radiographic development of osteoarthritis in individuals who underwent corticosteroid and hyaluronic acid injections.  

While the injections offered temporary relief for some patients, Azad Darbandi, a medical student and researcher, determined that their long-term implications on disease progression were unknown. Corticosteroid therapy resulted in much more advanced cases of medial joint space narrowing (a characteristic of osteoarthritis) than hyaluronic acid injections or no treatment.  

At baseline, all patients had identical imaging results. Still, two years later, those who had received corticosteroid injections fared worse than those who had had hyaluronic acid injections or no medicine at all. This is true for Darbandi.

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