Are cortisone injections good or bad for arthritic knees?


By Dennis Thompson
HealthDay Reporter

TUESDAY, December 21, 2021 (HealthDay News) – Cortisone injections have gained little popularity in recent years as a treatment for arthritis pain because steroids are known to damage cartilage and can potentially cause further joint deterioration.

But a new study suggests that if used wisely, cortisone injections are as safe as other types of injections used for treatment knee arthritis.

Occasional injections of cortisone do not appear to cause knee failure faster than injections hyaluronic acid, a substance injected to lubricate arthritis-stiff joints, the researchers said.

“Knee replacement rates were, if nothing else, slightly lower in the group that received cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.

However, Felson added that the study only studied people who were rare cortisone injections to the knee, and should not be construed as giving the green light to regular injections in the years to come.

“What we know from a study we can trust is that a few injections of cortisone won’t really cause big problems,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause problems, but you can’t say that.”

Steroids are known to be toxic to cartilage, the connective tissue that prevents your bones from rubbing against each other, explained Dr. Melissa Leber, director of the Department of Sports Emergency Medicine at Icahn Medical School on Mount Sinai in New York City.

“If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.

A 2019 study published a triple the risk progression of arthritis of the knee in people who received repeated injections of cortisone, compared with people who never received an injection, Felson and his colleagues said in background notes.

Comparing two types of shots

However, no Clinical trials has ever compared the two most common types of knee arthritis injections, cortisone injections and hyaluronic acid injections, Felson said.

Those two types of shots do different things in the wrist, and are sometimes used in combination, Leber said.

Cortisone injections have an anti-inflammatory effect and help reduce pain, while hyaluronic acid injections are like a gel that provides lubrication to a diseased joint.

“You inject the WD40 almost into the knee. It works by allowing it to glide smoothly in the wrist,” Leber explained.

Unlike cortisone, hyaluronic acid gel not harmful to cartilage.

The latest study studied nearly 800 people with knee arthritis, of whom 4 out of 5 reported receiving cortisone injections due to knee pain. Others reported receiving injections of hyaluronic acid.

After seven years of follow-up, the researchers found that those who received steroid injections had no greater cartilage loss than those treated with hyaluronic acid.

In fact, people who received cortisone injections were about 25% less likely to need a complete knee replacement than those who received hyaluronic acid.

The message to patients with arthritis of the knee regarding cortisone injections is simple, Felson said: “Don’t be afraid.”

“There’s nothing wrong with that happening with one hit or even a few shots,” Felson said. “People need to be reassured. We shouldn’t avoid getting effective treatment.”

Wise use is key

The findings support the approach of orthopedic experts already using cortisone to treat knee arthritis, Leber said.

“If someone already has a ton of knee cartilage damage, a lot of arthritis, then we don’t care so much about using steroids to control pain because they already have a lot of knee arthritis,” Leber said. Providing good pain control is a very small thing. It’s not that risky.

“In someone who is young, 20 to 40 years old, who has very little cartilage damage but has pain, we try to use it sparingly,” she continued. “Would you use them occasionally with a young person? Yes. It’s just a one-off. You don’t want to use it repeatedly.

The steroid is bad for cartilage, but that does not mean that it is bad for every patient, Leber concluded. – This is a case-by-case situation.

Nonetheless, you would not expect any patient to receive frequent cortisone injections, regardless of their condition, added Dr. Jeffrey Schildhorn, an orthopedic surgeon at Lenox Hill Hospital in New York City.

“If you give someone a chance in January, and he comes back in April and says he wants another one, and he comes back in August and he wants another one, how well are they doing?” said Schildhorn, who was not part of the study. “They don’t work if you only get two or three months of relief.”

A new study was recently published in the journal Arthritis and rheumatology.

More information

The Cleveland Clinic has more about knee arthritis.

SOURCES: David Felson, MD, Professor of Medicine and Epidemiology, Boston University; Melissa Leber, MD, Director of the Department of Emergency Sports Medicine, Icahn School of Medicine in Mount Sinai, New York City; Jeffrey Schildhorn, MD, Orthopedic Surgeon, Lenox Hill Hospital, New York; Arthritis and rheumatology, December 1, 2021


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