Evidence builds for long-term ineffectiveness of steroid shots for knee OA
YOUR DOSE OF MEDICINE - Charles C. Chante MD (The Philippine Star) - March 17, 2019 - 12:00am

Real-world, nontribal research confirms the findings of a high-profile study released earlier in 2017. Corticosteroid shots are ineffective in the long term for knee osteoarthritis.

In fact, researchers found a greater likelihood of a worsening condition in knees treated with the injections.

“Our findings are consistent with the latest randomized, controlled trial.” She spoke in a plenary presentation about the study findings at the annual meeting of the American College of Rheumatology.

The use of corticosteroids for knee OA is controversial topic. As there has been wide disagreement among medical societies about whether the treatment is useful in the long term for patients with pain flare-ups.

An updated 2015 Cochrane Library systemic review and meta-analysis identified 27 studies into the treatment and reported that “intra-articular corticosteroids may cause a moderate improvement in pain and a small improvement in physical function, but the quality of the evidence is low and results are inconclusive.”

For the randomized, controlled study released in 2017, researchers tracked 140 patients aged 45 and older with inflammation of the synovial membrane. They were randomly assigned to injections of intra-articular triamcinolone or a placebo.

After two years of injections every 12 weeks, there was no difference in reported pain between the intervention and control groups.  Also, those who received injections lost more cartilage.

Researchers launched the new study to seek insight through a real-life cohort. They examined findings from the Osteoarthritis Initiative, a longitudinal study of 4,796 patients aged 45-79 at four US clinics underwent annual examinations at baseline and annually for four years.

In an adjusted structural analysis, knees replacement or worsening of Kellgren Lawrence grade at the tibial femoral joint was more likely in 149 injection knees than 2,191 noninjection knees (odds ratio, 5.74; 95 percent confidence interval, 2.01-16.42).

Knee replacement or joint space width worsening at the tibial femoral joint was also more likely 120 injection knees than 2,112 non-injection knees (OR, 1.64; 95 percent CI, 0.91-2.93).

In another analysis, researchers tracked 134 injection knees (58 whose OA progressed) and 498 noninjection knees (132 whose OA progressed) for up to eight years. After adjustment, the injection knees were more likely to have progressed (hazard ratio, 1.60; 95 percent CI, 1.21-2.12).

“Several explanations may account for our study findings,” is that corticosteroids may hurt chrondocytes by, among other things, inducing apoptosis and synovial membrane inflammation.

It’s also possible, that patients may feel pain relief after injections and subsequently boost the risk of OA progression by increasing their physical activity.

It was noted the study’s limitations, including the fact that the patients who received injections had more pain at baseline, potentially indicating they had worse structural lesions that are more susceptible to progression.

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