Cortisone injections are safe and should not be avoided because of knee damage fears

(Boston)—Knee osteoarthritis (OA) also known as degenerative joint disease or “wear and tear” arthritis, affects one in eight Americans over the age of 50 and is associated with reduced quality of life and increased mortality. Cortisone shots, also known as intra-articular corticosteroid injections (CSI) and hyaluronic acid injections (HAI) are popular treatments for this disease yet recent studies have raised the concern that knees treated with CSI are at high risk of OA progression.

A new Boston University School of Medicine (BUSM) study shows that cortisone injections in the knee do not cause significant cartilage loss or increase the risk of knee replacement.

Previous studies had suggested that cortisone injections might increase disease progression including cartilage loss, but “a limitation of previous studies is that subjects receiving CSI were not compared to those receiving comparable treatment. Patients receiving CSI have more advanced knee OA, itself a risk factor for disease progression,” explained corresponding author David T. Felson, MD, MPH, professor of medicine and epidemiology at BUSM and Boston University School of Public Health.

Felson and his colleagues studied people with knee arthritis who were participants in two large longitudinal studies and who reported therapeutic injections into their knees with either cortisone or HAI. The latter treatment has been reported to delay knee replacement and it is thought to have no effect on cartilage loss. After seven years of follow-up, those who got steroid injections had no greater cartilage loss than those who got HAI and those who got steroid injections actually had a slightly reduced rate of knee replacements compared to those getting HAI.

According to the researchers, patients often receive CSI in an attempt to delay surgery. “Our data should provide reassurance to clinicians and patients. The risk of OA progression attributed to CSI in earlier studies may reflect more advanced disease in those receiving injections,” added Felson who also is a rheumatologist at Boston Medical Center.

These findings appear in the journal Arthritis and Rheumatology.

Funding for the study was provided by NIH grants U01-AG018820, U01AG18832; U01AG18947; U01AG19069 and P30 AR072571 and support from the NIHR Manchester Biomedical Research Centre.