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Steroid injections may worsen knee arthritis, studies suggest

Steroid injections used to relieve the pain of knee osteoarthritis actually may worsen the disease's progression, according to two studies presented Tuesday at a national radiology meeting. Photo by Amaskincare.com/Wikimedia Commons
Steroid injections used to relieve the pain of knee osteoarthritis actually may worsen the disease's progression, according to two studies presented Tuesday at a national radiology meeting. Photo by Amaskincare.com/Wikimedia Commons

Nov. 29 (UPI) -- Steroid injections used to relieve the pain of knee osteoarthritis actually may worsen the disease's progression, according to two studies presented Tuesday at the Radiological Society of North America's annual meeting.

Nationwide, osteoarthritis affects more than 32.5 million adults, making it the most common form of arthritis, according to the Centers for Disease Control and Prevention.

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According to the researchers, more than 10% of people with knee osteoarthritis, a chronic, degenerative and progressive condition, seek noninvasive treatment for pain relief via corticosteroid or hyaluronic acid injections.

For both studies presented at the meeting, researchers used groups of people from the Osteoarthritis Initiative, a multicenter, observational study of nearly 5,000 participants with knee osteoarthritis now in its 14th year of follow-up.

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The first study, led by researchers at the University of California, San Francisco, included 210 participants, 70 of whom received intraarticular injections, and a control group of 140 who did not receive injections during a two-year period.

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Of the 70 patients who received injections, 44 were injected with corticosteroids, and 26 were injected with hyaluronic acid.

According to a news release, the treatment and control groups were matched by age, sex, body mass index, pain and physical activity scores, and severity of disease.

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All patients received MRI scans at the time of the injection, and two years before and after, using a grading system for knee osteoarthritis that focuses on the meniscus, bone marrow lesions, cartilage, joint effusion and ligaments.

The investigators found that corticosteroid knee injections were "significantly associated with the overall progression of osteoarthritis in the knee, specifically in the lateral meniscus, lateral cartilage and medial cartilage," the release said.

By contrast, hyaluronic acid knee injections were not significantly associated with the progression of osteoarthritis in the knee. Compared to the group that did not receive injections, the group that got hyaluronic injections showed a decreased progression of osteoarthritis, specifically in bone marrow lesions.

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Dr. Upasana Upadhyay Bharadwaj, a research fellow in the Department of Radiology at University of California-San Francisco, said the study represented the first direct comparison of corticosteroid and hyaluronic acid injections using MRI scans in this way.

While both corticosteroid and hyaluronic acid injections may help with 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," Bharadwaj said.

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"Hyaluronic acid, on the other hand, may slow down progression of knee osteoarthritis and alleviate long term effects while offering symptomatic relief."

In the second study, researchers at the Chicago Medical School of Rosalind Franklin University of Medicine and Science compared the radiographic progression of osteoarthritis in patients who received injections of corticosteroids and hyaluronic acid.

The scientists looked at 150 patients with similar baseline characteristics: 50 of them received corticosteroid injections, 50 got hyaluronic acid injections, and 50 were not injected over a 3-year period.

The groups were matched by sex, body mass index and X-ray findings.

Patients had X-ray imaging of the knee at baseline and two years later, and the researchers looked at joint space narrowing, formation of bone spurs, and bone thickening around the knee cartilage, the release said.

Compared to patients who had a hyaluronic acid injection or no treatment, patients injected with corticosteroids "had significantly more osteoarthritis progression, including medial joint space narrowing, a hallmark of the disease," the release 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," researcher and medical student Azad Darbandi said in the release.

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