Steroid injections increased cartilage loss in knee arthritis

Quarterly corticosteroid injections for knee osteoarthritis increased cartilage loss over the course of 2 years without providing any clinical benefit, according to a randomized controlled trial published in the May 16 issue of JAMA.

By Honor Whiteman, Medical News Today 16 May 2017

Study co-author Timothy E. McAlindon, of Tufts Medical Center in Boston, MA, and colleagues found that steroid injections administered every 3 months were no better than a placebo for alleviating knee pain in patients with knee osteoarthritis (OA).

In fact, the researchers found that steroid injections actually led to a greater loss in the volume of bone cartilage over 2 years.

“Although the cartilage loss was not associated with worsening of symptom outcomes, rates of cartilage loss have been associated with higher rates of arthroplasty, raising the possibility of potential for longer-term adverse consequences on the health of the joint.” – Timothy E. McAlindon MD MPH. Medscape

Based on their findings, McAlindon and colleagues recommend against the use of steroid injections for the treatment of knee OA.

OA, also referred to as degenerative joint disease, is the most common form of arthritis, affecting more than 30 million adults in the United States.

OA is caused by the breakdown of cartilage, the tissue that covers and protects the ends of bones, and it most commonly affects the joints of the knees, hips, hands, and spine. The “wear and tear” of cartilage can lead to pain, inflammation, and movement problems.

There is currently no cure for OA, but there are treatments that can help to manage symptoms of the condition.

One such treatment that may be recommended is corticosteroid injections; some studies have suggested that these injections may improve pain for patients with knee OA.

The new research, however, suggests that corticosteroid injections are of no use to patients with knee OA, and that they may even make the condition worse.

Triamcinolone led to greater loss of bone cartilage volume

The team’s findings come from an analysis of 140 patients with symptomatic knee OA. All patients had inflammation of the synovial membrane, which lines the joints.

Every 12 weeks for 2 years, 70 of the patients received an injection with the corticosteroid triamcinolone, which was delivered directly to the knee joint. The remaining 70 participants received a placebo in the form of a saline solution.

Compared with patients who received the placebo, those who received triamcinolone experienced a greater loss in cartilage volume; patients who received triamcinolone saw a cartilage thickness loss of 0.21 millimeters, compared with 0.10 millimeters for the placebo group.

Furthermore, the researchers identified no significant differences in pain levels between the two groups, and patients who received triamcinolone experienced a greater number of adverse events related to treatment.

The researchers note some limitations to their study. For example, they say it is possible that corticosteroid injections may have offered short-term pain relief for patients, which could have been missed by their pain measuring methods.

Still, McAlindon and colleagues believe that their findings indicate that patients with knee OA are unlikely to benefit from corticosteroid injections. The researchers conclude: “These findings do not support this treatment for patients with symptomatic knee osteoarthritis.”

Source Medical News Today and Medscape

This trial compares the effects of intra-articular triamcinolone vs saline injected every 3 months for 2 years on changes in cartilage volume and pain in older adult patients with knee osteoarthritis. Published on YouTube May 16, 2017

Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial, Timothy E. McAlindon, DM, MPH; Michael P. LaValley, PhD; William F. Harvey, MD; Lori Lyn Price, MAS; Jeffrey B. Driban, PhD; Ming Zhang, PhD; Robert J. Ward, MD. JAMA. 2017;317(19):1967-1975. doi:10.1001/jama.2017.5283

Intra-articular Corticosteroids for Osteoarthritis of the Knee, Bruno R. da Costa, PhD; Roman Hari, MD; Peter Jüni, MD, FESC. JAMA. 2016;316(24):2671-2672. doi:10.1001/jama.2016.17565

Intra-articular corticosteroid for knee osteoarthritis, Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da Costa BR. Cochrane Database Syst Rev. 2015 Oct 22;(10):CD005328. doi: 10.1002/14651858.CD005328.pub3.