Steroid use for knee osteoarthritis may make it worse, studies say


Common medications 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 approximately 800,000 patients per year in the US alone,” said the lead author of one of the studies, Dr. Upasana Bharadwaj.

Osteoarthritis is a common form of arthritis in which the cartilage in the joints wears down over time and the surrounding bone changes, making it worse over time, according to the U.S. Centers for Disease Control and Prevention.

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

The study, presented at the annual meeting of the Radiological Society of North America, used radiographic or MRI images to track the progression of osteoarthritis in patients’ knees. Some of these patients received no treatment and others received corticosteroid or hyaluronic acid injections, according to the study.

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

However, just because the picture may look worse, it doesn’t mean people feel sick, said Azad Darbandi, lead author of the other study.

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

The study highlights a debate in the osteoarthritis scientific community about the role of changes in joint structure. Today, pain is the most recognized symptom, says Jason Kim, the Arthritis Foundation’s vice president of osteoarthritis research. Kim did not participate in the study.

The takeaway from the study is that corticosteroids should be used with caution for osteoarthritis pain.

Hyaluronic acid injections can be a good option for pain management but are underutilized because research is lacking, and most patients have to pay out of pocket, Darbandi said.

“Maybe hyaluronic acid injections should be studied for pain management 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 cause patients to develop other problems, such as infections because corticosteroids suppress the immune system, he said.

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

For a long-term strategy, Kim recommends building a team of trusted health care providers, including primary care physicians, orthopedic specialists, physical therapists, nutritionists and rheumatologists.

It can help manage weight and body mass index, or BMI, to improve metabolic effects and reduce overall inflammation, Kim said. It’s also important to try to exercise and be physically active, he said, adding that walking has been shown to improve arthritis.


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