Knee Arthritis Worsened by Corticosteroid Injections

A new study from UC San Francisco has revealed that corticosteroid injections for knee osteoarthritis may accelerate joint degeneration, unlike hyaluronic acid injections which appear to slow disease progression. The research challenges common clinical practices and could shift treatment guidelines to ensure safer long-term patient outcomes.

A recent study from the University of California, San Francisco has revealed that corticosteroid injections, often administered to relieve knee pain from osteoarthritis, are associated with accelerated degeneration of the joint. The research, published in the journal Radiology, challenges a common clinical practice and suggests hyaluronic acid injections as a potentially safer alternative.

“Our study directly challenges a common clinical practice: the use of corticosteroid injections for knee osteoarthritis symptom relief. It presents robust evidence that corticosteroids accelerate structural knee degeneration, even after a single injection,” Upasana Upadhyay Bharadwaj, M.D., who led the research team while she was a research fellow in UC San Francisco’s Department of Radiology, said in a news release.

Osteoarthritis is the most prevalent form of arthritis, impacting approximately 528 million people globally, with the knee being the most commonly affected joint. Many patients seeking non-invasive pain relief for this chronic and progressive condition opt for either corticosteroid or hyaluronic acid injections.

The research analyzed data from 210 participants in the Osteoarthritis Initiative, a longitudinal study involving nearly 5,000 individuals with knee arthritis.

The researchers examined 70 participants who received either corticosteroid or hyaluronic acid injections and had MRI scans before, at the time of, and two years following the injection.

Using a semi-quantitative MRI evaluation (WORMS), the researchers assessed structural changes within the knee joint over time.

“This study is the first to use WORMS to assess the progression of knee osteoarthritis following a single intra-articular injection of either corticosteroids or hyaluronic acid, with a two-year follow-up,” added Upadhyay Bharadwaj. “Prior studies relied predominantly on X-ray assessments or advanced quantitative MRI requiring specialized postprocessing. Unlike those, this study uses semi-quantitative scoring feasible in clinical settings and isolates patients who received only one injection.”

Of the 70 patients receiving injections, 44 were treated with corticosteroids, while 26 received hyaluronic acid.

The study found that corticosteroid injections led to more significant knee joint deterioration compared to the control group and those treated with hyaluronic acid.

Conversely, hyaluronic acid injections were linked to slower progression of joint damage and even appeared to mitigate the structural deterioration.

“The most striking finding is that a single corticosteroid injection led to significantly greater structural damage in the knee joint over two years, especially in cartilage, while hyaluronic acid injections not only avoided this damage but actually showed reduced joint deterioration post-injection,” Upadhyay Bharadwaj added.

She explained that corticosteroids may inhibit cartilage repair mechanisms, causing weakened cartilage and heightened vulnerability to damage.

This study could lead to a paradigm shift in treating knee osteoarthritis, potentially prompting clinicians to reconsider the frequent use of corticosteroid injections.

“Given their widespread use, these findings could influence clinical guidelines and patient care decisions, encouraging more cautious use and stronger consideration of alternatives like hyaluronic acid,” added Upadhyay Bharadwaj. “The public impact is significant, as osteoarthritis is a major global cause of disability, and millions receive such injections annually.”

The researchers concluded that modifying treatment practices might improve long-term joint health and patient outcomes, especially for those with mild to moderate osteoarthritis who are not yet surgical candidates. Further investigation and evolving guidelines could enhance pain management strategies and overall care for osteoarthritis patients worldwide.

Source: Radiological Society of North America