Intra-Articular Corticosteroids for Osteoarthritis Pain May Damage Joints
Intra-articular corticosteroid injections in the hip and knee for the treatment of osteoarthritis (OA) may not be as safe as had been believed, according to findings of a new review.1
This determination comes after the authors evaluated reports in the literature of complications after treatment with corticosteroid injections and observed that the injections may be associated with the following main adverse joint events:
- Accelerated OA progression with loss of joint space
- Subchondral insufficiency fracture
- Complications of osteonecrosis
- Rapid joint destruction, including bone loss
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“We’ve been telling patients that even if these injections don’t relieve your pain, they’re not going to hurt you,” lead review author Ali Guermazi, MD, PhD, a professor of radiology and director of the Quantitative Imaging Center at Boston University School of Medicine, said in a press release. “But now we suspect that this is not necessarily the case.”2
According to Dr Guermazi and colleagues, clinicians’ awareness is growing about these adverse joint events that occur in patients after intra-articular corticosteroid injection. As such, clinicians may consider adding these risks to patient consent forms.
“Physicians do not commonly tell patients about the possibility of joint collapse or subchondral insufficiency fractures that may lead to earlier total hip or knee replacement,” Dr Guermazi said. “This information should be part of the consent when you inject patients with intra-articular corticosteroids.”2
The increased clinical awareness can also aid clinicians in familiarizing themselves with imaging findings and patient characteristics, which in turn may help them identify which joints could be at risk for an adverse joint event following an intra-articular corticosteroid injection that is combined with local anesthetics.
“Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications,” the authors concluded.1
—Colleen Murphy
References:
1. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? [published online October 15, 2019]. Radiology. doi:10.1148/radiol.2019190341.
2. Steroid injections of hip and knee may damage joints [press release]. Oak Brook, IL: Radiological Society of North America; October 15, 2019. https://www.rsna.org/en/news/2019/October/Steroid-Injections-Hip-Knee. Accessed October 16, 2019.