Do Steroid Injections Make Knee Osteoarthritis Severe?

Steroid Injections Significantly Associated With Progression of Knee OA

The Osteoarthritis Initiative, a multicenter, longitudinal, observational study that presently has approximately 5,000 patients with KOA and is in its 14th year of follow-up, was used by researchers in both investigations.

In the first study, which had 210 people and was carried out by researchers at the University of California, San Francisco, 70 subjects received intraarticular injections—44 of steroids and 26 of hyaluronic acid. The control group, which consisted of the remaining 140 participants, received no injections.

When previous therapies have failed to relieve knee discomfort, hyaluronic acid injections are employed. According to one theory, the injections might aid in lubricating joints where osteoarthritis has damaged the cartilage.

ions could help lubricate joints where cartilage has been eroded by osteoarthritis.

Age, sex, body mass index, pain, physical activity scores, and the degree of knee osteoarthritis in the treatment and control groups were all equal.

The researchers tracked the evolution of osteoarthritis by comparing the imaging results from the first scans and the two-year follow-up scans for each subject, who underwent an MRI at the time of the injection as well as two years before and after.

Researchers discovered that steroid knee injections, specifically in the lateral meniscus, lateral cartilage, and medial cartilage, were strongly linked to the overall progression of osteoarthritis in the knee.

Hyaluronic acid knee injections

Hyaluronic acid knee injections, on the other hand, were not significantly linked to the development of knee osteoarthritis. The group that received hyaluronic injections demonstrated a slower progression of osteoarthritis than the control group, particularly in bone marrow lesions.

“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,” said coauthor Upasana Upadhyay Bharadwaj, MD, a research fellow in the department of radiology at University of California in San Francisco, in a press release. “While both corticosteroid and hyaluronic acid injections are reported to help with symptomatic pain

According to the findings, hyaluronic acid may prevent knee osteoarthritis from progressing while simultaneously relieving symptoms, he stated.

X-Ray Reveals Greater KOA Progression at 2 Years in Group That Received Steroid Injections

In the second study, researchers performed an observational study to assess the radiographic progression of osteoarthritis in patients who had corticosteroid injections against hyaluronic acid injections (the most popular imaging technique to identify OA).

From the Osteoarthritis Initiative database, researchers selected a group of 150 patients with comparable baseline characteristics, of which 50 had corticosteroid injections, 50 had hyaluronic acid injections, and 50 had none throughout a three-year period. By matching the groups based on sex, body mass index, and X-ray results.

In order to identify changes in the narrowing of the joint space, the development of bone spurs, and the thickening of the bone around the knee cartilage, researchers examined baseline and follow-up X-ray images of the knees.

Patients who had a steroid injection considerably progressed osteoarthritis more than those who received a hyaluronic acid injection or no injections, including medial joint space narrowing, a defining feature of KOA.

When compared to patients who received hyaluronic acid injections or no treatment at all, patients who received corticosteroid injections had worse imaging signs of osteoarthritis two years later, according to coauthor Azad Darbandi, a researcher and medical student at Chicago Medical School of Rosalind Franklin University of Medicine and Science. According to Darbandi, the findings indicate that hyaluronic acid injections should be researched further for the treatment of KOA symptoms and that steroid injections should be used with more caution.

Experts Agree: Better Options for Treating Knee OA Are Needed

According to Bruno R. da Costa, Ph.D., associate professor at the Institute of Health Policy, Management, and Evaluation at the University of Toronto, whose research interests include osteoarthritis, both studies have small sample sizes and are non-randomized, making them typically more likely to have biases and statistical errors. Dr. da Costa didn’t take part in any of the studies.

Since MRI exams are expensive, using them in research is frequently not practical, according to da Costa. It’s a clever approach, he argues, to leverage data from the Osteoarthritis Initiative to answer this study issue. Given the methodological flaws, the degree of the evidence produced is very low, but these results could aid future studies in larger, randomized trials, the author writes.

According to da Costa, improper use of steroids might be dangerous. “There is solid evidence that short-term steroid use is superior to placebo, but not in the mid-to-long-term,”

Da Costa adds that there is unambiguous proof that hyaluronic acid injections are not more effective than a placebo injection in the treatment of osteoarthritis pain. Meanwhile, he adds, “there is substantial evidence that this treatment is linked to major adverse outcomes.”

Meta-analysis Indication

In July 2022, a meta-analysis coauthored by Da Costa indicated that hyaluronic acid injections did not significantly reduce pain in patients with KOA and were instead associated with a higher risk of serious side events than a placebo. The findings do not support the widespread use of viscosupplementation (with hyaluronic acid injections) for the treatment of knee osteoarthritis, according to the study’s authors.

Jason Kim, MD, vice president of osteoarthritis research programs at the Arthritis Foundation, told NBC news that the foundation does not recommend steroids or hyaluronic acid injections for people with arthritis.

Better treatments for KOA are required so that scientists are not forced to “compare one imperfect agent to another,” according to Dr. Kim.