New Study States Common Treatment For Arthritis May Accelerate Disease Progression

At a recent meeting of the Radiological Society of North America, the findings of two recent studies were presented, which stated that corticosteroid injections, a common treatment used for those with osteoarthritis, could actually accelerate the progression of the disease. 

Embed from Getty Images

At the 2022 annual meeting of the Radiological Society of North America (RSNA), two studies were presented that showed evidence that corticosteroid injections, a commonly used treatment against the pain that comes with osteoarthritis, could actually cause the disease to progress further. 

According to Science Tech Daily, 32.5 million adults in the US deal with osteoarthritis, a disease that breaks down and degenerates cartilage in the joints. Knee osteoarthritis affects around 800,000 Americans every year. When osteoarthritis is in the knee, it impacts the individual’s mobility and can be quite painful. 

10% of individuals with knee osteoarthritis go for noninvasive treatments to assist with their pain. Corticosteroid or hyaluronic acid injections are the most common noninvasive treatments to assist with alleviating the pain caused by osteoarthritis in the knee. 

In the studies presented at RSNA’s annual meeting, researchers discussed data acquired from cohorts involved in the Osteoarthritis Initiative; an observational study with about 5,000 participants with knee osteoarthritis. The study is currently in its 14th year of follow-ups with participants. Upasana Upadhyay Bhardwaj, a research fellow in the Department of Radiology at University of California, San Francisco, discussed how the use of MRI in these studies was a revolutionary way to take in the data.

“This is the first direct comparison of corticosteroid and hyaluronic acid injections using the semi-quantitative, whole organ assessment of the knee with MRI.”

Within the study from the University of California, San Francisco, researchers “included 210 Osteoarthritis Initiative participants, 70 of whom received intra articular injections, and a control group of 140 who did not receive injections during a two-year period. Of the 70 patients who received injections, 44 were injected with corticosteroids, and 26 were injected with hyaluronic acid. The treatment and control groups were matched by age, sex, body mass index, pain and physical activity scores, and severity of the disease,” according to Science Tech Daily’s report on the meeting. 

MRI’s were performed on participants at the time of injections as well as two years before and after to review the changes made to the cartilage, joints, and bone marrow of the knee from the injections. 

The statistical analysis that came from the study showed an overall progression of knee osteoarthritis, specifically those who received corticosteroid injections. The hyaluronic acid knee injections didn’t show a major progression of the osteoarthritis in the knee, and actually showed a decrease in bone marrow lesions. 

“While both corticosteroid and hyaluronic acid injections are reported to help with symptomatic pain relief for knee osteoarthritis, our results conclusively show that corticosteroids are associated with significant progression of knee osteoarthritis up to two years post-injection and must be administered with caution,” Dr. Upadhyay Bharadwaj said.

Embed from Getty Images

“Hyaluronic acid, on the other hand, may slow down the progression of knee osteoarthritis and alleviate long-term effects while offering symptomatic relief.”

Embed from Getty Images

The second study discussed at the meeting came from researchers at the Chicago Medical School of Rosalind Franklin University of Medicine and Science. This study was case-controlled, and also observed the changes made to those with osteoarthritis who received corticosteroid and hyaluronic acid injections. 

“While these injections provide some patients with short-term pain relief, the effects of the injections on the progression of the disease are unknown,” said researcher and medical student Azad Darbandi.

According to Science Tech Daily, “Darbandi’s team selected a cohort of 150 patients with similar baseline characteristics from the Osteoarthritis Initiative database, including 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who were not injected over a 36-month time period. The groups were matched by sex, body mass index, and X-ray findings.”

“Even though imaging findings for all patients were similar at baseline, the imaging hallmarks of osteoarthritis were worse two years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all,” Darbandi said.

“The results suggest that hyaluronic acid injections should be further explored for the management of knee osteoarthritis symptoms and that steroid injections should be utilized with more caution.”

“Knowing the long-term effects of these injections will help osteoarthritis patients and clinicians make more informed decisions for managing the disease and the pain it causes,” Dr. Upadhyay Bharadwaj stated.