Steroid Injections May Damage Hip and Knee Joints

A new study suggests that intra-articular corticosteroid (IACS) injections could lead to accelerated joint destruction, and may hasten the need for total hip and knee replacements.

Researchers at Boston University School of Medicine (BUSM; MA, USA), the French National Institute of Sports (INSEP; Paris, France), and Friedrich-Alexander University Erlangen-Nürnberg (FAU; Germany) undertook a review of the existing literature in order to describe observed adverse joint events following the administration of IACS injections to treat osteoarthritis (OA) pain, and also to provide an outlook on how this may affect clinical practice.

The researchers identified four main adverse outcomes: accelerated osteoarthritis progression with loss of the joint space, osteonecrosis complications, subchondral insufficiency fractures (stress fractures beneath the cartilage), and rapid joint destruction, including bone loss. They thus recommend careful scrutiny of patients with mild or no OA on X-rays who are referred for IASC, especially when the pain reported is disproportionate to imaging findings, and that patients need to be told of the potential consequences of a corticosteroid injection before they receive it. The study was published on October 15, 2019, in Radiology.

“Intra-articular joint injection of steroids is a very common treatment for osteoarthritis-related pain, but potential aggravation of pre-existing conditions or actual side effects in a subset of patients need to be explored further to better understand the risks associated,” said lead author Professor Ali Guermazi, MD, PhD, of BUMC. “We've been telling patients that even if these injections don't relieve your pain, they're not going to hurt you. But now we suspect that this is not necessarily the case.”

OA is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes--hereditary, developmental, metabolic, and mechanical deficits--may initiate processes leading to loss of cartilage. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax. OA of the knee affects about 250 million people worldwide (3.6% of the population).

Related Links:
Boston University School of Medicine
French National Institute of Sports
Friedrich-Alexander University Erlangen-Nürnberg