Osteoarthritis is the most common form of arthritis, a chronic degenerative disease. Corticosteroid injections are commonly used to relieve pain in patients with osteoarthritis of the knee, however these drugs may have long-term adverse effects as two new studies have found they are associated with disease progression. Their results have been presented at the annual meeting of the Radiological Society of North America (RSNA).
To conduct both studies, the authors selected cohorts from the Osteoarthritis Initiative, an observational study of nearly 5,000 participants with knee osteoarthritis who have been followed for 14 years. The first of the works has been carried out by researchers from the University of California in San Francisco with 210 participants of the Osteoarthritis Initiative, 70 of whom received intra-articular injections and 140 who did not receive them (control group), during a period of two years. Participants were matched based on their gender, age, BMI (body mass index), pain and physical activity scores, and disease severity.
44 of the 70 patients who received injections were injected with corticosteroids, and 26 were injected with hyaluronic acid. All patients underwent an MRI at the time of injection and at two years, and test results were assessed using the Whole Organ MRI Score (WORMS), a classification system for osteoarthritis. knee surgery that focuses on meniscus, bone marrow, cartilage, joint effusion, and ligament injuries.
“The results suggest that hyaluronic acid injections should be further explored for the treatment of knee osteoarthritis symptoms.”
To determine the progression of osteoarthritis, they compared the imaging scores from the baseline scans and the two-year follow-up scans. “This is the first direct comparison of corticosteroid and hyaluronic acid injections using semiquantitative whole-organ evaluation of the knee with MRI,” said Dr. Upasana Upadhyay Bharadwaj, a researcher in the Department of Radiology at the University of California, San Francisco.
Corticosteroids versus hyaluronic acid for knee arthritis
Statistical analysis revealed that corticosteroid injections in the knee were significantly associated with the overall progression of osteoarthritis in the knee, specifically in the lateral meniscus, lateral cartilage, and medial cartilage. In contrast, no significant association was found between hyaluronic acid injections in the knee and the progression of osteoarthritis in the knee. In addition, the group that received hyaluronic acid injections showed decreased progression of osteoarthritis, specifically in bone marrow lesions, compared to the control group that did not receive the treatment.
“While corticosteroid and hyaluronic acid injections are reported to help relieve symptomatic pain of knee osteoarthritis, our results show conclusively that corticosteroids are associated with significant progression of knee osteoarthritis up to two years after injection and should be administered with caution,” said Dr. Upadhyay Bharadwaj. “Hyaluronic acid, on the other hand, can slow the progression of knee osteoarthritis and alleviate the long-term effects while offering symptomatic relief.”
The second study was conducted by researchers at the Rosalind Franklin University of Medicine and Science Chicago School of Medicine who focused on a case-control study to compare the radiographic progression of osteoarthritis in patients receiving corticosteroid and acid injections. hyaluronic “While these injections provide some patients with short-term pain relief, the effects of the injections on disease progression are unknown,” said researcher and medical student Azad Darbandi.
His team selected a cohort of 150 patients with similar baseline characteristics from the Osteoarthritis Initiative database, including 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who did not receive injections, over a period of 36 months. Participants were matched by gender, BMI (body mass index), and X-ray results.
X-ray images of the participants’ knee were taken at the start of the study and two years later, and the researchers analyzed these images, including joint space narrowing, bone spur formation, and bone thickening around the knee cartilage. . They found that patients injected with corticosteroids had significantly greater progression of osteoarthritis, including narrowing of the medial joint space, a hallmark of the disease, compared with patients who received a hyaluronic acid injection or those who received no treatment was administered.
“Although imaging results for all patients were similar at baseline, imaging features of osteoarthritis were worse two years later in patients who received corticosteroid injections compared with patients who received hyaluronic acid injections or no hyaluronic acid injections. treatment”, concludes Darbandi. “The results suggest that hyaluronic acid injections should be further explored for the treatment of knee osteoarthritis symptoms and that steroid injections should be used with more caution.”
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