Should we abandon corticosteroid injections for knee osteoarthritis?
The Risks and Limitations of Intra-Articular Corticosteroid Injections (IACIs) for Knee Osteoarthritis
The information on the blog is solely derived from High quality Systematic reviews, RCTs and Meta-analyses of the median and long term effects of IACIs when compared to placebo and alternative treatments.
Knee osteoarthritis is a chronic condition that can lead to significant pain, discomfort, and even disability. Many treatments aim to relieve symptoms, with intra-articular corticosteroid injections (IACIs) being a popular option for short-term pain relief. While IACIs may provide temporary comfort, evidence suggests that they fall short in delivering medium- or long-term benefits. Even advocates of this treatment now acknowledge its limitations over time.
The Hidden Risks of IACIs
Emerging research has raised concerns about the long-term effects of IACIs on knee osteoarthritis. Several studies indicate that patients receiving these injections may experience worse outcomes compared to those given placebo injections. The reason? Corticosteroids could potentially accelerate cartilage degeneration, increasing the likelihood of needing knee surgery, which comes with its own risks, including infection and complications.
Are Alternative Treatments the Answer?
Proponents of IACIs often highlight the uncertainties surrounding alternative treatments, such as platelet-rich plasma (PRP) injections. They argue that more research is needed to determine if these alternatives offer better outcomes. However, this debate about alternatives misses a critical point. If IACIs fail to provide long-term benefits and carry risks of long-term harm, the focus should shift to discontinuing their use rather than waiting for conclusive data on other treatments. Continuing to rely on a treatment with known drawbacks undermines the core medical principle of "first, do no harm."
A Flawed Logic
The reasoning behind continued support for IACIs is troubling. If we applied the same logic to other medical interventions, such as surgeries, it could lead to dangerous outcomes. Imagine continuing a surgical practice proven to cause more harm than good simply because an ideal alternative has not yet been identified. Such an approach not only shifts the burden of proof inappropriately but also promotes a biased preference for maintaining the status quo, despite evidence of potential harm.
In conclusion, while IACIs may offer temporary relief for knee osteoarthritis, the risks of long-term damage make their continued use questionable at best. Until safer and more effective treatments are confirmed, the priority should be patient safety and reconsidering the routine use of corticosteroid injections for this condition.
Main take home messages
These injections may provide short term pain relief making them an enticing option for many but they seem to have no long term benefits past a couple of months.
There is evidence that these injections cause more harm to the joint and increase the likelihood of more invasive treatments in the long term.
The continued use of injections seems to be linked to there being no better alternative treatment offered for quick short term pain relief.
References
Orchard, J (2022) Pay attention to the evidence: in the longer term, intraarticular corticosteroid injection offers only harm for knee osteoarthritis, Osteoarthritis and cartilage, in press Journal pre-proof.
Wijin SRW, Rovers MM, Van Tienen TG, Hannink G. Intraarticular corticosteroid injections increase the risk of requiring knee arthroplasty. Bone Joint Lett J 2020;102-b:586e92.
Mclarnon M, Heron N. Intra-articular platelet rich plasma injection versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis BMC Musculoskel Discord 2021;22:550
McAlindon TE,LaValley MP, Harvey WF, Prince LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pin in patients with knee osteoarthritis: a randomized clinical trial. JMA 2017;317:1967e75
