Using steroids for knee osteoarthritis can make it worse, studies say

Using steroids for knee osteoarthritis can make it worse, studies say


Common treatments for some arthritis pain may actually make the condition worse, according to two new studies.

“Knee osteoarthritis is one of the most chronic, degenerative and progressive conditions, with an estimated incidence of 800,000 patients each year in the US alone,” said lead author of one of the studies, Dr. Upasana Bharadwaj.

Osteoarthritis is a common form of arthritis where the cartilage inside the joint breaks down over time and the bones around it change, worsening over time, according to the US Centers for Disease Control and Prevention.

At least 10% of patients in the study used the injections for pain relief, added Bharadwaj, who is a postdoctoral researcher in the department of radiology at the University of California, San Francisco School of Medicine. Two of these injectable pain relievers are corticosteroids, the more common of the two, and hyaluronic acid.

Studies, presented at the annual meeting of the Radiological Society of North America, used radiographs or MRI images to monitor the progression of osteoarthritis in patients’ knees. Some of these patients received no treatment, and others received injections of corticosteroids or hyaluronic acid, according to the studies.

Both studies showed a statistically significant increase in the progression of degenerative changes in knee cartilage over two years in people who received corticosteroid injections compared with those who received hyaluronic acid or no injections, according to the study authors.

However, just because the images might look worse doesn’t always mean people feel more pain, said Azad Darbandi, lead author of the second study.

“You may see that the knee looks bad on an X-ray, but the patient may not have worse symptoms,” added Darbandi, a researcher and medical student at the Rosalind Franklin University of Medicine and Science Chicago School of Medicine.

The studies underscore the debate in the osteoarthritis scientific community about the role of changes in joint structure. Currently, pain is the primary recognized symptom, said Jason Kim, the Arthritis Foundation’s vice president of osteoarthritis research. Kim was not involved in any of the studies.

The study concluded that corticosteroids should be used with caution in osteoarthritis pain.

Hyaluronic acid injections may be a promising option for pain relief, but it is less widely used because there is less research and most patients have to pay out of pocket, Darbandi said.

“Hyaluronic acid injections for pain control may need to be studied more thoroughly,” he said.

Corticosteroids are a quick way to relieve pain and control inflammation, but may not be a good option for long-term treatment, Kim said. Repeated injections can put patients at risk for other problems, such as infections, because corticosteroids suppress your immune system, he said.

And some people may not see significant benefit from steroid or hyaluronic acid injections, Kim added.

For a long-term strategy, Kim recommended creating a trusted team of health care providers, including your primary care physician, orthopedic specialist, physical therapist, nutritionist and rheumatologist.

It may be helpful to control weight and body mass index, or BMI, to improve metabolic effects and reduce overall inflammation, Kim said. It is also important to try to exercise and be physically active, he said and added walking has been proven to improve arthritis.


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