There is no cure for osteoarthritis, and treatment involves managing the symptoms through weight loss, exercise and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Injections of corticosteroids, which reduce inflammation, are another option.
But the shots are only effective for some patients, and even then the pain relief is temporary, Guermazi said. If they caused no harm, he added, that might not be a problem. But that’s not the case.
“If a patient with osteoarthritis is considering this treatment,” Guermazi said, “we need to tell them it might not help them, and it might cause harm.”
The findings are based on 459 patients who had one to three corticosteroid injections for hip or knee arthritis in 2018. Overall, 26 patients (6%) showed a quick progression of their arthritis; three patients suffered rapid joint destruction, including bone loss; four had stress fractures (all in the hip); and three had complications from osteonecrosis, where bone tissue “dies.”
On average, the complications were detected seven months after the corticosteroid injection.
The study was not a clinical trial, and that is its main limitation, Azar pointed out: The patients’ complications cannot be definitively attributed to corticosteroids.
But, Guermazi said, the findings are in line with what the JAMA study showed, and suggests there are additional serious risks.
Azar said that if you have worsening osteoarthritis pain and your doctor suggests corticosteroids, you might want to ask for an imaging test first. The new pain might be due to something else, like a tear in the meniscus (a cartilage pad in the knee).
But beyond that, patients should ask about corticosteroid alternatives, both Azar and Guermazi said.
“You can’t underestimate the importance of weight loss and physical therapy,” Azar said.
If medication is needed, she said she typically starts with topical NSAIDs, and then moves to “judicious use” of oral versions, since long-term NSAID use carries risks, too.
For more severe chronic pain, medications for nerve-related pain can be an option, Azar said. They include drugs like Cymbalta, Lyrica and Neurontin.
Another expert said sometimes corticosteroid shots are the way to go.