This common osteoarthritis treatment may damage joints

Radiological Society of North America

In a new study, researchers found corticosteroid injections used to treat osteoarthritis pain in the hip and knee may be more dangerous than previously thought.

They suggested that injection-associated risks include rapid progressive osteoarthritis, which eventually may lead to joint collapse.

The research was led by Boston University School of Medicine.

Osteoarthritis of the hip and knee are common and debilitating joint disorders.

Physicians often inject anti-inflammatory corticosteroids into the joint to treat the pain and swelling associated with osteoarthritis.

The procedure is widely viewed as safe, and patient consent forms mainly mention the risks of hemorrhage and infection among more rare side effects associated with most needle-based procedures.

However, in the study, the team found that corticosteroid injections may be linked to complications that potentially accelerate the destruction of the joint and may hasten the need for total hip and knee replacements.

In a review of existing literature on complications after treatment with corticosteroid injections, the team identified four main adverse findings: accelerated osteoarthritis progression with loss of the joint space, subchondral insufficiency fractures (stress fractures that occur beneath the cartilage), complications from osteonecrosis (death of bone tissue), and rapid joint destruction including bone loss.

The researchers recommend careful scrutiny of patients with mild or no osteoarthritis on X-rays who are referred for injections to treat joint pain, especially when the pain is disproportionate to the imaging findings.

Prior research has shown that these patients are at risk of developing rapid progressive joint space loss or destructive osteoarthritis after injections.

Physicians may also want to reconsider a planned injection when the patient has an acute change in pain not explained by X-rays as some underlying condition affecting joint health may be ongoing.

Most importantly, younger patients and patients earlier in the course of the disease need to be told of the potential consequences of a corticosteroid injection before they receive it.

The lead author of the study is Ali Guermazi, M.D., Ph.D., professor of radiology and medicine.

The study is published in the journal Radiology.

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