One of the most common arthritis pain-relieving treatments, corticosteroid injections, may actually be associated with faster disease progression, according to new research.
Osteoarthritis, the most common type of arthritis, occurs when the cartilage that cushions a joint breaks down over time, causing pain and stiffness. More than 32 million American adults have this condition, which most commonly affects the hands, hips, and knees. There is no cure, but the discomfort is sometimes treated with corticosteroid injections. Hyaluronic acid injections are also used, although they are less likely to be covered by insurance.
Two small unpublished studies, to be presented Tuesday at the annual meeting of the Radiological Society of North America, found that, on average, knee arthritis progressed more rapidly among patients who received corticosteroid injections than among those who did not. . In contrast, hyaluronic acid injections were associated with slower disease progression relative to a control group.
“Our papers show that there should be a lot more awareness that corticosteroids could have a potential progression of OA” or osteoarthritis, said Azad Darbandi, a medical student at Chicago Medical School and co-author of one of the studies.
Both studies evaluated patients from the Osteoarthritis Initiative, a year-long observational research project involving nearly 5,000 people with osteoarthritis of the knee. Darbandi’s research looked at X-rays from 50 patients who received corticosteroid injections, 50 who received hyaluronic acid and another 50 in a control group. The scans, collected annually for four years, revealed worse arthritis progression among corticosteroid-injected participants compared with the other two groups.
The second study, from the University of California, San Francisco, examined MRI scans of 210 participants, 44 of whom received corticosteroid injections and 26 of whom received hyaluronic acid.
The researchers looked at scans taken at the time of the injections, as well as two years before and after, and found more severe cartilage deterioration at the two-year follow-up among the steroid group.
“Knowing that helps patients make a more informed decision about whether they want an injection and, if they do, which injection they prefer,” said Dr. Upasana Bharadwaj, a postdoctoral researcher in the UCSF department of radiology and biomedical imaging and study co-author. to study.
But previous research on this topic is mixed. A 2019 report suggested that corticosteroid injections to the hips and knees could accelerate the condition and even hasten the need for joint replacement operations. But a analysis last year found a similar progression of arthritis between those who received steroids and those who received hyaluronic acid.
Dr. Jonathan Samuels, a rheumatologist at NYU Langone Health, said it’s hard to determine cause-and-effect in studies like the two new ones, because so many factors can influence the progression of arthritis, and no two patients are the same.
“We don’t have the biology to show that the injection itself is causing accelerated damage. It is difficult to connect the dots from injection to damage from these preliminary data,” he said. “But it’s an important question, because it’s a very common practice to be injected with steroids.”
Dr. Jason Kim, vice president of osteoarthritis research programs at the Arthritis Foundation, said he would like to see studies with a “much larger sample size over a longer period of time” before considering possible causal links.
Bharadwaj and Darbandi agreed that more research is needed, as is peer review of their studies.
Bharadwaj noted that his team tried to control for the possibility that people who received steroid injections were simply more likely to engage in activities that furthered the progression of their arthritis afterward. To do this, they selected participants who had maintained similar activity levels throughout the study period.
Darbandi offered some caveats to keep in mind along with the findings. One, she said, is that the results don’t necessarily indicate the severity of the symptoms that the patients experienced. The fact that the images show a greater progression of the arthritis does not mean that the patient feels more pain.
And second, he said, the results should not lead people to avoid corticosteroid injections in all situations.
“Even though they might progress osteoarthritis, that doesn’t mean they don’t have a beneficial aspect or that they shouldn’t be used,” Darbandi said, “because they’re effective in the short term to put a Band-Aid on pain. ”
Kim said her foundation does not recommend corticosteroids or hyaluronic acid injections for people with arthritis. Overall, she said, better treatment options are needed so that researchers don’t have to “compare one flawed agent against another.”