The use of corticosteroid injections to relieve the pain of osteoarthritis in the knee has come under the microscope after researchers found that the common treatment method was linked to “significant progression” of the disease.
The findings from two studies into the matter were presented to the annual meeting of the Radiological Society of North America (RSNA) on Tuesday, November 29
The first study, conducted by researchers at the University of California, San Francisco, included 210 participants. As part of the study 70 participants received intraarticular injections, while the remaining 140 participants did not receive injections over the two-years study period.
Among the 70 study particiapants who received injections, 44 were injected with corticosteroids, and 26 were injected with hyaluronic acid. MRIs were performed on all patients at the time of the initial injection and two years after.
Upon examination of the MRIs, researchers found that participants who received the corticosteroid knee injections experienced increased progression of osteoarthritis in the knee.
Research fellow in the Department of Radiology at University of California, San Francisco, Upasana Upadhyay Bharadwaj, M.D said “this is the first direct comparison of corticosteroid and hyaluronic acid injections using the semi-quantitative, whole organ assessment of the knee with MRI.”
“While both corticosteroid and hyaluronic acid injections are reported to help with symptomatic pain relief for knee osteoarthritis, our results conclusively show that corticosteroids are associated with significant progression of knee osteoarthritis up to two years post-injection and must be administered with caution,” Upadhyay Bharadwaj said.
“Hyaluronic acid, on the other hand, may slow down progression of knee osteoarthritis and alleviate long term effects while offering symptomatic relief.”
Hyaluronic acid knee injections were found to not significantly contribute to the progression of the disease. In fact, the group who received the hyaluronic injections were found to have experienced a decreased progression of osteoarthritis.
Steroid injections worsen knee arthritis
Two studies comparing injections commonly used to relieve the pain of knee osteoarthritis found that corticosteroid injections were associated with the progression of the disease. https://t.co/pAeU3IzZfx pic.twitter.com/rgJeHM5t62
— Dr. John Cush (@RheumNow) December 4, 2022
In a second study, conducted by researchers at the Chicago Medical School of Rosalind Franklin University of Medicine and Science, researchers also compared the progression of osteoarthritis in patients who received injections of corticosteroids compared to hyaluronic acid.
Over a 3 year study period, researchers examined 150 patients, which included 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who were not injected.
The study reaffirmed the previous findings, with participants injected with corticosteroids showing more osteoarthritis progression when compared to those who received hyaluronic acid or no treatment.
Researcher and medical student Azad Darbandi said “the results suggest that hyaluronic acid injections should be further explored for the management of knee osteoarthritis symptoms, and that steroid injections should be utilized with more caution.”
“Even though imaging findings for all patients were similar at baseline, the imaging hallmarks of osteoarthritis were worse two years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all,” Darbandi said.
Researchers are hopeful that the findings will help both patients and medical professionals when it comes to assessing treatment options.
“Knowing the long-term effects of these injections will help osteoarthritis patients and clinicians make more informed decisions for managing the disease and the pain it causes,” Upadhyay Bharadwaj added.
According to latest figures from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (NHS), 2.2 million (9.3 per cent) Australians have osteoarthritis.
The condition is most common in adults aged 75 and over, with over one-third (36 per cent) of the cohort experiencing the disease.
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