Steroid injections can worsen knee arthritis

Two of the more commonly used injections used to relieve pain in knee osteoarthritis found that corticosteroid injections were associated with
disease progression.
The results of these two studies were presented
today at the annual meeting of the Radiological Society of North America (RSNA).

Osteoarthritis is the most common form of arthritis, affecting 32.
5 million adults
in the United States.
Knee osteoarthritis is a chronic, degenerative and progressive disease that affects an estimated 800,000 people
each year.
More than 10% of patients with knee osteoarthritis seek noninvasive treatment for pain
relief with corticosteroids or hyaluronic acid injections.

Researchers in both studies selected cohorts from the Osteoarthritis Initiative, a multicenter, longitudinal, observational study that followed nearly 5,000 people with knee osteoarthritis for 14 years
.

In the first study, UCSF researchers included 210 participants in the osteoarthritis program, 70 of whom received intra-articular injections, compared with 140 in the control group who did not receive injections
for two years.
Of the 70 patients who received the injection, 44 were injected with corticosteroids and 26 with hyaluronic acid
.
The treatment and control groups matched age, sex, body mass index, pain and physical activity scores, and disease severity
.

MRI was performed on all patients at the time of injection and for two years before and after injection
.
MRI scans were evaluated using the Whole Organ Magnetic Resonance Imaging Score (WORMS), a grading system for knee osteoarthritis that focuses on meniscus, bone marrow lesions, cartilage, joint effusion, and ligaments
.
The researchers determined the progression of osteoarthritis by comparing imaging scores from the
initial scan and the two-year follow-up scan.

Upasana Upadhyay Bharadwaj, MD, a researcher in the Department of Radiology at UCSF, said: "This is the first time that a semi-quantitative, whole-organ assessment of the knee joint with MRI has been used to directly compare corticosteroids with hyaluronic acid injections
.
"

Statistical analysis showed that corticosteroid knee injections were significantly associated with the overall progression of knee osteoarthritis, particularly the lateral meniscus, lateral cartilage, and medial cartilage
.

Knee hyaluronic acid injection was not significantly associated
with the progression of knee osteoarthritis.
Compared to the control group, the group receiving hyaluronic acid injection showed a slowdown in the progression of osteoarthritis, especially in terms of
bone marrow lesions.

"While both corticosteroid and hyaluronic acid injections have been reported to help relieve symptomatic pain in knee osteoarthritis, our findings ultimately suggest that corticosteroids are associated with significant progression of knee osteoarthritis and must be used
with caution until two years after injection," said Dr.
Upadhyay Bharadwaj.
"On the other hand, hyaluronic acid may slow the progression of knee osteoarthritis, mitigating long-term effects while providing symptom relief
.
"

In the second study, researchers at Rosalyn Franklin University School of Medicine and Science in Chicago conducted a case-control study comparing radiological progression
in osteoarthritis patients who received corticosteroid and hyaluronic acid injections.

Azad Darbandi, a medical student and a medical student, said: "Although these injections provided short-term pain relief to some patients, the effect of the injections on disease progression is unclear
.
"

Darbandi's team selected 150 patients with similar baseline characteristics from the osteoarthritis project database, including 50 who received corticosteroid injections, 50 patients who received hyaluronic acid injections, and 50 patients
who did not receive injections over a 36-month period.
The team matched
them based on gender, body mass index and X-ray results.

Patients undergo knee x-ray imaging at baseline and two years later
.
The researchers analyzed X-ray imaging including narrowing of the joint space, bone spur formation, and bone thickening
around the knee cartilage.

Patients injected with corticosteroids progressed significantly more severely in osteoarthritis, including narrowing of medial joint spaces, which is a hallmark
of the disease compared to patients who received hyaluronic acid injections or did not receive any treatment.

"Although imaging results were similar at baseline for all patients, patients who received corticosteroid injections had worse
imaging features of osteoarthritis two years later than those who received hyaluronic acid injections or no treatment at all," Darbandi said.
"The results suggest that hyaluronic acid injections should be further explored for the management of symptoms of knee osteoarthritis, while steroid injections should be used
more sparingly.
"

Dr.
Upadhyay Bharadwaj added, "Understanding the long-term effects of these injections will help osteoarthritis patients and clinicians make more informed decisions
about managing the disease and the pain it causes.
"