Corticosteroids Not a Contributor in Advanced Knee Osteoarthritis

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The use of corticosteroid injections may not be associated with the progression of knee osteoarthritis to the point of total knee replacement any more than the use of hyaluronic acid, according to a presentation made today at the American College of Rheumatology annual meeting.

Previously published studies suggested that corticosteroid injections may worsen knee osteoarthritis to the point of total knee replacement, but researchers of this study suspect that may have been simply because patients with more severe osteoarthritis were more likely to get corticosteroid injections.

In this study, which was presented by Justin J. Bucci, M.D., of Boston Medical Center, researchers analyzed 792 knees, of which 647 were treated with corticosteroid injections and 145 were treated with hyaluronic acid at least once (124 patients who received corticosteroids and 19 who received hyaluronic acid, were treated more than once).

“Steroid injections are considered a safe and effective intervention for relieving pain from knee osteoarthritis,” Dr. Bucci said in a press statement. Weight loss may relieve pain as well, but it is difficult for some patients to achieve, he said. And, pain medications may not be appropriate for all patients due to underlying morbidities, such as kidney disease.

In this study, researchers reviewed the rates of radiographic progression, or joint damage, documented on X-rays. Patients in the first group had medical visits every 12 months, and those in the second cohort had visits every 30 months. Their exams included knee X-rays and questions about their steroid or hyaluronic acid injections over the previous six months. Knee osteoarthritis progression was measured using two standard scores Kellen and Lawrence grades and medial joint space narrowing, both of which are radiographic measures

When they analyzed X-ray progression, the researchers excluded anyone with a baseline KL 4 score and anyone who had received either corticosteroid or hyaluronic acid injections in the past. They compared X-rays from each patient’s medical visits before their first injection to those taken after their last injection. They assigned KL and joint space narrowing scores to each X-ray at medical visits where total knee replacement surgery was prescribed.

Ultimately, the rate of total knee replacement surgery was greater among patients with a single exam where they reported hyaluronic acid injection compared to those with a single exam where they reported corticosteroid injection.

They did not find a difference in those patients reporting injections at multiple exams. Further analysis showed similar rates of X-ray progression for both injection treatments at either single or multiple medical exams.

“We did not find any association between steroid injections and worsening knee osteoarthritis in our study. Patients and clinicians should see this study and feel reassured that these injections are not causing progression of osteoarthritis or earlier total knee replacement,” Dr. Bucci said.

A limitation of this study is that patients who tend to have corticosteroid injections, usually have more advanced knee osteoarthritis.

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REFERENCE

ABSTRACT NUMBER: 1652. Progression of Knee OA with Use of Intra-articular Corticosteroids (CS) vs Hyaluronic Acid (HA). Justin Bucci. Date: Monday, November 9, 2020