Common Arthritis Treatment May Actually Accelerate Disease Progression

Osteoarthritis Knee Inflammation

Osteoarthritis is a degenerative joint disease that causes the cartilage in the joints to break down, leading to pain, stiffness, and difficulty moving. It is a common condition that often affects the hands, knees, hips, and spine. Risk factors for developing osteoarthritis include aging, obesity, and a history of joint injuries.

Two recent studies have shown that corticosteroid injections, which are commonly used to treat the pain associated with knee osteoarthritis, may actually contribute to the progression of the disease. These findings were recently presented at the annual meeting of the Radiological Society of North America (RSNA).

Osteoarthritis is a widespread condition that affects 32.5 million adults in the United States and is characterized by the degeneration and breakdown of cartilage in the joints. Knee osteoarthritis, which affects approximately 800,000 people each year, is a chronic and progressive condition that can cause pain and difficulty moving. Approximately 10% of individuals with knee osteoarthritis seek noninvasive treatments and turn to corticosteroid or hyaluronic acid injections to alleviate their pain.

Researchers in both studies chose cohorts from the Osteoarthritis Initiative, a multicenter, longitudinal, observational study of nearly 5,000 participants with knee osteoarthritis currently in its 14th year of follow-up.

Steroid Injections Worsen Knee Arthritis

Knee joint of a patient showing (A) severe cartilage defects and (B) intact knee joint. Credit: RSNA and Upasana Upadhyay Bharadwaj, M.D.

In the first study, researchers at the University of California, San Francisco included 210 Osteoarthritis Initiative participants, 70 of whom received intraarticular injections, and a control group of 140 who did not receive injections during a two-year period. Of the 70 patients who received injections, 44 were injected with corticosteroids, and 26 were injected with hyaluronic acid. The treatment and control groups were matched by age, sex, body mass index, pain and physical activity scores, and severity of the disease.

MRI was performed on all patients at the time of the injection and two years before and after. The MRI scans were assessed using whole-organ magnetic resonance imaging score (WORMS), a grading system for knee osteoarthritis that focuses on the meniscus, bone marrow lesions, cartilage, joint effusion, and ligaments. The researchers identified osteoarthritis progression by comparing the imaging scores from the initial scans and two-year follow-up scans.

“This is the first direct comparison of corticosteroid and hyaluronic acid injections using the semi-quantitative, whole organ assessment of the knee with MRI,” said Upasana Upadhyay Bharadwaj, M.D., a research fellow in the Department of Radiology at University of California, San Francisco.

Statistical analysis showed 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.

Hyaluronic acid knee injections were not significantly associated with the progression of osteoarthritis in the knee. Compared to the control group, the group who received hyaluronic injections showed a decreased progression of osteoarthritis, specifically in bone marrow lesions.

“While both corticosteroid and hyaluronic acid injections are reported to help with symptomatic 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,” Dr. Upadhyay Bharadwaj said.

“Hyaluronic acid, on the other hand, may slow down the 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 conducted a case-control study comparing the radiographic progression of osteoarthritis in patients who received injections of corticosteroids and hyaluronic acid.

“While these injections provide some patients with short-term pain relief, the effects of the injections on the progression of the disease are unknown,” said researcher and medical student Azad Darbandi.

Darbandi’s team selected a cohort of 150 patients with similar baseline characteristics from the Osteoarthritis Initiative database, including 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who were not injected over a 36-month time period. The groups were matched by sex, body mass index, and X-ray findings.

Patients underwent X-ray imaging of the knee at baseline and two years later. The researchers analyzed the X-ray imaging, including joint space narrowing, formation of bone spurs, and bone thickening around the knee cartilage.

Compared to patients who received an injection of hyaluronic acid or no treatment at all, patients injected with corticosteroids had significantly more osteoarthritis progression, including medial joint space narrowing, a hallmark of the disease.

“Even though imaging findings for all patients were similar at baseline, the imaging hallmarks of osteoarthritis were worse two years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all,” Darbandi 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.”

“Knowing the long-term effects of these injections will help osteoarthritis patients and clinicians make more informed decisions for managing the disease and the pain it causes,” Dr. Upadhyay Bharadwaj added.

Meeting: 108th Scientific Assembly and Annual Meeting of the Radiological Society of North America

Dr. Upadhyay Bharadwaj’s co-authors are Thomas Link, M.D., Ph.D., Zehra Akkaya, Gabby Joseph, John Lynch, Ph.D., and Paula Giesler. Darbandi’s co-authors are Sean Hormozian, Atefe Pooyan, M.D., Ehsan Alipour, M.D., Firoozeh Shomal Zadeh, M.D., Parham Pezeshk, M.D., and Majid Chalian, M.D.

22 Comments on "Common Arthritis Treatment May Actually Accelerate Disease Progression"

  1. Sadly, we’re still living in the Dark Ages of medicine even after discovering stem cells, fully decoding the basic genome of human DNA, etc. We either do nothing with what we discovered, don’t know how to do anything with it or Big Pharma pays off the inventors to not do anything with it because everything from cold pills, nasal spray and pain pills are HUGE HUGE MONEY for the industry and they sure as hell don’t want that gravy train to ever stop. Many insurance companies also won’t pay for treatments that work better (knee injections of gel, for example) before trying steroid injections at least TWICE over a year (so damage your knees further to satisfy their demand you do something CHEAPER).

    Notice how even the Covid vaccine turned out to be mostly useless for newer versions. They know if they target the base of the virus that doesn’t mutate, it will work for every version and maybe even some other cold virus corona viruses, but that would mean ONE last sale instead of year after year after year after year of selling Flu vaccines that don’t work very well.

    Can you even imagine the pressure and death threats anyone who tries to bring something to market would face when it comes to BILLIONS of dollars in profits being destroyed by an actual freaking CURE. No, I’m not crazy. That’s how life really works. People are FLIPPING EVIL. Period. Money, fame and power are the ONLY things that matter to human garbage.

  2. Captain Jack is correct. This study is ancient news. Everyone in the field has known this for 50 years. Insurance continues to pay for it even though it is well known the crystalline formation is abrasive and erodes cartilage leading to the #1 procedure in ortho medicine, the arthroscopy. Also proven to be at the most 50% effective. It’s a scam.

  3. This is old news, these shots are NOT a cure. They just buy people time / help put off a knee replacement. If you need a knee injection then the damage has already be done, don’t expect a miracle.

  4. This world is getting uglier and uglier, … let alone whether it was ever truly civilized or ever will! Technology advances come with moral degradation. So the future with AI is unsettingly unknown,

  5. I had two courses (three in each knee, 12 months apart) of hyaluronic acid injections in my knees approx. 5-6 years ago. It was early enough in my condition that I achieved complete remission of symptoms–pain and stiffness–and that has persisted to this day. Used early, hyaluronic acid injections are extremely effective for long-term remission of symptoms.

  6. Anybody who knows inflammation also knows that it is the body,s natural healing process. Injecting anti inflammatory steroids blocks inflammation and any healing worsening the degeneration of the cartilage. What amazes me the most is that anti inflammatory meds are giving for the pain associated with inflammation. Why not give pain meds and let the inflammation work to complete any possible healing. I could easily predict the outcome of the research described in the article based on the simple understanding of inflammation

  7. When will the FDA approve Stem Cell Therapies for All ailments, so medicare and insurance could help people pay for this that I Know will help??

  8. Does anyone know if the price of a Snickers bar has gone up since Biden was placed into the White House?

  9. As a physical therapist I have seen the above to be true for years and encourage my dad not to do the cortisone but to go the route of gel that staved off his total knee replacements and he was mobile at the age of 94, when cause of death was not osteoarthritis. However, it’s refreshing to see this in the literature and it needs to be flagged instead of buried because like captain Jack and the others… we’ve known this for years!

  10. Cortisone injections mask the knee pain resulting in continued wear of the joint. The patient continues his/her activities with less pain thinking the knee is no longer deteriorating. I’m not sure if this was considered in the study. This might be the cause of further progression rather than the cortisone itself.

  11. In my 70s and probably am the poster child for all of these treatments.. from the almost useless scraping to the newest clinical trial I am enrolled in. Bottom line is that after all these years there is nothing that gives folks the relief they are look for. The closest for me was simple Meloxicam. Great pain relief and decreased inflammation. I’m almost 2 months in a double blind placebo clinical trial that hasn’t done anything yet. Perhaps I’m in the placebo group . We’ll see.

  12. Yup. I have knee osteoporosis and was denied the chicken shots because insurance wouldn’t pay for it until I had 3 cortisone shots first. It’s a scam. And they say the mafia is bad!

  13. Primary purpose of inflammation is to fight infection. Everybody just too afraid to touch medic’s holy cow of undiagnosed chronic infections.

  14. Frank, you’re ridiculous to blame that on the president, the whole world is going through the same thing. Inflation. Recession.

  15. Bit of a struggle if you are old, of limited income and have oa in your knee. Most people over 60 probably shouldn’t have nsaids (renal toxicity) other than occasionally and opioids increase falls risk and reduce pain thresholds in anything other than short term use, and of course the newer injections are much more expensive. If you are 70 to 80 yrs old steroid injections are a low cost way of keeping going. These are always decisions made on risks and benefits. Most knee injections given by gp’s don’t actually enter the joint cavity but still seem to achieve good analgesia. Would be interesting to know if the knee injections in the study were confirmed to enter the joint cavity

  16. Elisabeth Anderson | December 31, 2022 at 2:49 am | Reply

    I hoped to read more regarding hip injections.

  17. My symptoms started in 2018 when I had a total knee replacement it’s the worst pain ever here I am in 2022 going on two 2023 and my knee hurts worse than it did before I had the total knee replacement it feels like I can feel all the screws in there my knees inflamed I can feel the joints the screws whatever they put in me I can feel them they hurt so bad . I wish I had never had a tkr. Worst pain ever every day 24 seven 365 days a week a year I’m in pain.

  18. Mercedes Ciolek | January 2, 2023 at 8:36 am | Reply

    I got a steroid injection 20 years ago, and the doctor said it would make the problem worse in the long run. I recently had both my knees replaced and it was one of the best things I’ve ever done for myself.

  19. They'll own everything soon, just get sick and die | January 4, 2023 at 3:48 pm | Reply

    First they get the rat sick. Then they test something that was tested before. The rays died, but the other rats lived, great, switch-apply the research. We caught you just in time, try this. Still feel like you’re dying, soon enough, try this. Does patient have x, if there’s prescribe what’s in the box. Did it work if no, prescribe this box. Do you want to pass need school now that you owe 100,000? If ya, prescribe what’s in the box. The little children thought the nazzi scientists were doctors, them they got an idea

  20. I had torn the cartilage in my left knee in 2placesin 2018 3drs wanted to keep giving me the cordisine shots and send me to pt I knew it was torn my shin would be limp when I tried to bend it burned, etc.they didn’t want me to wear a brace I bought 1 i hpped from dec26_2018-march2019 I saw another doctor in feb got a mri , surgery in march.feb 2022 it tore again I had 4shots over the summer 3drs again the last one I like , I might have to get a partcial replacement it’s torn I had 2mris the last 1was in november its torn had to go to pt , they put ankle weight on my left ankle didn’t want me to brace been doing it it feels like it want to give away at times the last Dr said I have arthritus narrowing of my joint, I’m not goinng to take no more shots I’m glad I found this also in my case the shots I got over summer made my hair split down the middle, scalp itched bad it was the cordisone shots

  21. "Digits" Dave Chronicknee | January 4, 2023 at 11:35 pm | Reply

    In the words of that Billy Joel song; “Cptn Jack has saved my life tonight”, or words to that effect, unless we think of ‘Cptn Jack Sparra’; still appropriate though, when considering the skull and crossbones of ye average pirate of old, and talking of old bones, (how’s that for a Segway?) my first finger after the index finger has quite suddenly flared up with “trigger finger” and terrible joint pain at the base of the palm. If I forget it and tap a flip top bottle lid closed, I’m suddenly in momentary agony from an arthritic joint on the palm. Other times a searing pain can suddenly surge through the top of the corresponding finger as if right inside the bone, leaving me grabbing my finger in agony with my other hand. At other times, If I forget, and straighten out my finger using its hand muscles I’m reminded by sharp pain and bone ache. Upon waking I can find my finger curled under so far that it’s almost touching my palm I know not to give it full muscle power to try to open it as this would not move it and it any attempt causes pain, it could also pull off a small piece of bone where the tendon is attached, such as with “Malet finger”. Instead, I have to wait, warm it under hot water, massage the palm which also hurts, then try gently working the very tip of the finger a millimeter at a time, forwards and backwards, repeatedly until I can move it enough to try, with pain, to straighten – at first the tip, then the middle, which then clicks and springs up. It’s as if an upper tendon over the top is too short due to the arthritic swelling of the bony joint, the tendon stretches a little to reach that point (though not a very stretchy substance as anyone who has prepared a raw chicken might understand) then as the finger rides up and over the maximum stretch point the tendon relaxes back and the finger is no longer curled. It’s agony and worrying! I’m guessing the base joint is swollen and this means the tendon has farther to go to reach the finger tip but of course, it cannot suddenly grow 2mm and so is pulling too much.

    As it’s less painful to keep the finger straight over night, I decided a splint would be beneficial. Rather than picking up a deadly virus at a walk in clinic because there are too few MDs/GPs and as such it takes two months to see my doctor, (no exaggeration!) I used 4 mini-ice cream sticks around my finger bound by *only two thin strips of duct tape *to allow for ventilation. I later found I was allergic to the adhesive in the gaps so covered those with another thin strip on the inside at the widest end nearest the palm. It makes a cone shape open on four sides bound like the rings on a beer keg or whiskey barrel but only top and bottom. This holds together allowing me to easily slide the whole thing on an off with relative ease, so as for tasks where our hands may get wet, unhygienic or plain dirty, etc. It’s been a saving grace. Sometimes it’s too painful and I’ll leave the splint off and instead place my hand flat under a pillow when sleeping on my side or under my other arm so as to keep that finger from curling.

    I hope these tips may help anyone suffering from the same condition. Now I must lay down this – stupid idea; the “Not So Smart Phone”!

    I’ve had only little experience of this before, though over many years I’ve noticed aches in my hand joints that would come and go now and then, but which have never remained for long periods. This time it’s far worse, sudden, alarming and seems permanent! It is quite worrying to say the least, especially as I have aches in the less used hand also! Imagine if both hands become unusable! Just last week I noticed a bony ridge, which took me aback! It’s as if it’s at the farthest point of the bone in the palm where it hits the first finger section. I cannot grip anything and if holding anything small like cutlery, a small tool or pen, I cannot release them when putting them down, so end up shaking them out from that remaining finger not released! I frequently have to manually release the finger tip with my other hand which hurts every time it ‘pops’.

    My quality of life is impaired and I cannot work the same nor do the things I enjoyed as before without full use of this hand and I’m not even all that old. I use my smart phone a lot for gaming and messaging and I wonder if it has exacerbated an existing, mild problem more prone to developing as we age.

    At the same time, I suddenly got Planter Fasceitis of the Achilles tendon strap at the back of the heel, right foot and a little on the left. It surges with an intense bruise-like pain out of no where and hurts to walk, then just as mysteriously, it vanishes for a while! An hour or a day later it ‘reminds me who is boss’ again. Weird or what? I’m wondering if there can be any connection seeing as the heel pain and the arthritic trigger finger/hand joint began in ernest at the same time even though my diet/ total ingestion hasn’t changed.

    If people are putting profits before the suffering of others (and most of us realise they are) evil is the correct term and I hope they get their just deserts as soon as possible! I believe no one escapes justice whether in this life, another life or in death, there is such a thing as karma, I’ve seen it in action all too often, I guess when you don’t see it happen within someone’s lifetime, that’s when it’s going to be real bad for them! Watch out tobacco industry and illicit drug cartels – fate has your name and number! Wha suffering you cause to other may be metered out on you in due course.

  22. What is the solution then?

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