Common treatments for joint pain may be linked to hastening arthritis progression, study suggests

Corticosteroid injections, one of the most common pain relief treatments for arthritis, may actually be linked to hastening the progression of the disease, according to new research.

Osteoarthritis, the most common type of arthritis, occurs when the cartilage that cushions the joints breaks down over time, causing pain and stiffness. Over 32 million US adults suffer from this condition, which most frequently affects the hands, hips and knees. There is no cure, but the discomfort may be treated with corticosteroid injections. Hyaluronic acid injection is also performed, but it is not 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Two small, unpublished studies to be presented Tuesday at the annual meeting of the Radiological Society of North America found that, on average, patients who received corticosteroid injections progressed more rapidly with knee arthritis than those who did not. In contrast, hyaluronic acid injections were associated with slower disease progression compared to the control group.

“Our paper shows that we should be more aware that corticosteroids can advance OA, or osteoarthritis,” said Chicago, who co-authored one of the studies. said Azad Darbandi, a medical student at a medical school.

Both studies evaluated patients in the Osteoarthritis Initiative, a year-long observational research project involving nearly 5,000 knee osteoarthritis patients. Darbandi’s study analyzed her X-rays of 50 of her patients who received corticosteroid injections, 50 of her patients who received hyaluronic acid, and another 50 of her patients in a control group. Did. Scans collected annually for four years revealed worse progression of arthritis in participants injected with corticosteroids compared to the other two groups.

A second study from the University of California, San Francisco examined MRI scans of 210 participants. Of those, 44 received corticosteroid injections and 26 received hyaluronic acid.

The researchers looked at scans taken at the time of injection and two years before and after and found that the group taking steroids had more severe cartilage deterioration by the two-year follow-up mark. rice field.

“Knowing that will help patients make more informed choices about whether they want injections and, if so, which ones they prefer,” the study said.

However, previous research on this subject is mixed.a 2019 report proposal Injections of corticosteroids into the hip and knee may accelerate the condition and even hasten the need for joint replacement surgery. Analysis of last year A similar progression of arthritis was seen between those who took steroids and those who took hyaluronic acid.

Dr. Jonathan Samuels, a rheumatologist at NYU Langone Health, said many factors can affect the progression of arthritis, and no two patients are the same, so studies like the two new studies are trying to establish a causal relationship. He said it is difficult to identify.

“There is no biological evidence to prove that the injection itself causes accelerated damage. From this preliminary data, it is difficult to connect the dots from injection to injury,” he said. “But this is an important issue because injecting steroids is a very common practice.”

Jason Kim, Ph.D., vice president of the Arthritis Foundation’s Osteoarthritis Research Program, said he would like to see studies with “larger sample sizes over longer time periods” before considering possible causation. rice field.

Bharadwaj and Darbandi agreed that more research was needed, as was peer review of their work.

Bharadwaj said her team sought to control for the possibility that people who received steroid injections were more likely to subsequently engage in activities that accelerate the progression of arthritis. We selected participants who maintained their activity level.

Darbandi provided some caveats to keep in mind along with the findings. One is that the results do not necessarily indicate the severity of symptoms experienced by the patient. It does not mean.

And second, the results should not lead to avoiding corticosteroid injections in all situations.

“It may advance osteoarthritis, but that doesn’t mean it doesn’t have a beneficial aspect or shouldn’t be used,” Darbandi said. “

Kim said his foundation does not recommend corticosteroids or hyaluronic acid injections for people with arthritis. He said there is a need for better treatment options.