Cortisone Shots Could Be Making Your Knee Arthritis Worse, Doctors Warn

Osteoarthritis—a condition that occurs “when the protective cartilage that cushions the ends of the bones wears down over time,” causing the bones to rub together—is the most common form of arthritis, according to Mayo Clinic. It most commonly affects the hips, knees, hands, and spine. The Centers for Disease Control & Prevention (CDC) estimates that 32.5 million U.S. adults, or about 12.4 percent of the adult population, have osteoarthritis.

When it comes to knee osteoarthritis, more than half of those with the condition will undergo a total knee replacement at some point. However, this surgery can be off-limits for those with a history of blood clots, and it entails a lengthy, often painful, recovery. That’s why those who decide against a knee replacement (or those who are waiting to see if their knee pain improves) turn to non-invasive treatments like corticosteroid or hyaluronic acid injections. However, while the latter can decrease the progression of knee osteoarthritis, corticosteroid shots can actually make it worse, according to new research.

RELATED: Can You Delay a Knee Replacement? New Treatment Approach May Eliminate Pain.

Steroid injections can make knee arthritis worse.

A new study published this week in the journal Radiology compared the effectiveness of corticosteroid injections (commonly referred to as “cortisone shots”) and hyaluronic acid injections (often called “knee gel injections”) to treat knee osteoarthritis.

“Our study directly challenges a common clinical practice: the use of corticosteroid injections for knee osteoarthritis symptom relief,” said Upasana Upadhyay Bharadwaj, MD, who was a research fellow in the Department of Radiology at the University of California, San Francisco, at the time of the research, according to a press release. “It presents robust evidence that corticosteroids accelerate structural knee degeneration, even after a single injection.”

To arrive at these findings, the researchers analyzed the health data of 70 participants with knee osteoarthritis who had one of the two injections (44 received a corticosteroid and 26 hyaluronic acid), with whole-organ semi-quantitative MRI evaluations (WORMS) taken before, at the time of, and two years after the treatment to assess how the arthritis had progressed in the knee. This was compared with a control group of 140 people with knee osteoarthritis who received no injections.

“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 2-year follow-up,” Bharadwaj said. “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.”

Compared to both the control group and the hyaluronic acid group, the participants who received corticosteroid shots exhibited the following:

• More knee joint damage over the two-year period, despite reduced knee pain
• Evidence of changes in subchondral bones, the layer of bone directly underneath cartilage in a joint
• Risk of insufficiency fracture, a type of stress fracture that occurs in a weakened bone

“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,” explained Bharadwaj. “Corticosteroids are known to reduce inflammation but also impair the repair mechanisms of cartilage and can inhibit matrix synthesis.”

Bharadwaj hopes the research may encourage doctors to rely more heavily on hyaluronic acid injections, “especially for patients with mild to moderate osteoarthritis who are not yet surgical candidates.”

RELATED: 10 Best Exercises for Knee Pain, According to Fitness Experts.

Genicular artery embolization (GAE) could be another alternative to cortisone shots.

Last year, a “minimally invasive procedure” called genicular artery embolization (GAE) was presented at the annual meeting of the Radiological Society of North America (RSNA). The researchers behind the treatment for knee osteoarthritis noted that steroid injections only “mask the symptoms” and eventually become ineffective when the arthritis has progressed.

However, the researchers found that GAE led to an 87 percent improvement in quality of life and a 71 percent improvement in pain after one year in knee osteoarthritis patients for whom other treatments did not work.

As Best Life previously reported. “In patients with osteoarthritis, the genicular arteries—which have branches that ‘form a network around the knee joint’—are altered. So, with GAE, a radiologist ‘injects small particles into selected branches that correspond to the site of knee pain to block blood flow to that area.’ This helps relieve inflammation, the wearing away of cartilage, and sensory nerve growth, the release explains.”