In a study, researchers compared two injections. Both of which are commonly used to relieve knee pain from osteoarthritis. They are corticosteroids and hyaluronic acid. However, they found that corticosteroid injections are a cause of progression in the disease. The research was published in Radiology. Nonetheless, hyaluronic acid had an association with decreased progression on MRI for up to two years after the injection.
What is osteoarthritis?
Osteoarthritis, the most common form of arthritis, affects about 528 million people worldwide based on the WHO’s statistics. Osteoarthritis of the knee is a chronic degenerative disorder and progressive as well. Moreover, the knee is the most frequently affected joint, and multiple patients with knee osteoarthritis seek non-invasive treatment. They include pain relief through corticosteroids or hyaluronic acid injections.
“Our study directly challenges a common clinical practice: the use of corticosteroid injections for knee osteoarthritis symptom relief,”
said Upasana Upadhyay Bharadwaj, M.D., who was a research fellow in the Department of Radiology at the University of California, San Francisco, at the time of the research.
“It presents robust evidence that corticosteroids accelerate structural knee degeneration, even after a single injection.”
Researchers examined the link between intra-articular injections—a procedure that involves injecting medication directly into a joint—and the progression of osteoarthritis over a two-year period. To evaluate changes in the knee joint, the team used a whole-organ semiquantitative MRI scoring method known as WORMS, along with clinical outcome assessments.
The study analyzed data from 210 participants enrolled in the Osteoarthritis Initiative, a large multicenter observational study involving nearly 5,000 men and women with knee osteoarthritis. The project, funded by the National Institutes of Health, has been tracking participants for more than 14 years.
Among the participants, 70 individuals received a single knee injection of either corticosteroids or hyaluronic acid. MRI scans were performed before the injection, at the time of treatment, and again two years later. Researchers used WORMS to measure structural changes and damage within different regions of the knee over time. The findings from these participants were then compared with a control group of 140 people with similar characteristics who did not undergo injection treatment.
“The most striking finding is that a single corticosteroid injection led to significantly greater structural damage in the knee joint over two years, especially in cartilage, while hyaluronic acid injections not only avoided this damage but actually showed reduced joint deterioration post-injection,”
“Corticosteroids are known to reduce inflammation but also impair the repair mechanisms of cartilage and can inhibit matrix synthesis.”
