Steroid use for knee osteoarthritis may make it worse, studies say



A common treatment for some arthritis pain could actually make the condition worse, according to two new studies.

“Osteoarthritis of the knee is one of the most chronic, degenerative and progressive diseases, with an estimated incidence of 800,000 patients per year in the US alone,” said lead author of one of the studies, Dr Upasana Bharadwaj.

Osteoarthritis is a common form of arthritis in which the cartilage in a joint breaks down over time and the bones around it change and get worse over time, according to the U.S. Centers for Disease Control and Prevention.

At least 10% of patients in the study used injections to manage pain, added Bharadwaj, who is a postdoctoral researcher in the department of radiology at the University of California San Francisco’s School of Medicine. Two of those pain management injectables are corticosteroids, the more common of the two, and hyaluronic acid.

The studies, presented at the annual meeting of the Radiological Society of North America, used X-rays or MRI images to track the progression of osteoarthritis in patients’ knees. Some of those patients received no treatment at all, and others received injections of corticosteroids or hyaluronic acid, the studies said.

Both papers showed a statistically significant increase in progression of degenerative changes in knee cartilage over two years in people who had corticosteroid injections compared to those who had hyaluronic acid or no injections, according to the study authors.

But just because the images might look worse doesn’t always mean the people feel more pain, said Azad Darbandi, lead author of the other study.

“You might see the knee look bad on an X-ray, but the patient may not have worse symptoms,” added Darbandi, a researcher and medical student at the Chicago Medical School of Rosalind Franklin University of Medicine and Science.

The studies highlight a debate in the scientific community about osteoarthritis about the role of changes in joint structure. Currently, pain is the most recognized symptom, said Jason Kim, the Arthritis Foundation’s vice president of osteoarthritis research. Kim was not involved in either investigation.

The conclusion of the studies is that corticosteroids should be administered with caution for osteoarthritis pain.

Hyaluronic acid injections may be a promising option for pain management, but are less used because there is less research and most patients have to pay out of pocket, Darbandi said.

“Perhaps hyaluronic acid injections should be studied more thoroughly for pain management,” he said.

Corticosteroids are a quick way to get pain relief and control inflammation, but may not be a good option for long-term treatment, Kim said. Repeated injections can put patients at risk for other problems, such as infections, because corticosteroids suppress your immune system, he said.

And some people may not see a significant benefit from steroid or hyaluronic acid injections, Kim added.

For a long-term strategy, Kim recommended building a trusted team of healthcare providers, including your family doctor, orthopedic specialist, physical therapist, nutritionist, and rheumatologist.

It could be helpful to control weight and body mass index, or BMI, to enhance metabolic effects and reduce overall inflammation, Kim said. It’s also important to try to exercise and be physically active, he said, adding that walking has been proven to improve arthritis.

The Valley Voice
The Valley Voice
Christopher Brito is a social media producer and trending writer for The Valley Voice, with a focus on sports and stories related to race and culture.


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