Abstract
Although intra-articular corticosteroid injections (IACI) are commonly used for the treatment of knee osteoarthritis (OA), there is controversy regarding possible deleterious effects on joint structure. In this line, this study investigates the effects of IACI on the evolution of knee OA structural changes and pain. Participants for this nested case–control study were from the Osteoarthritis Initiative. Knees of participants who had received an IACI and had magnetic resonance images (MRI) were named cases (n = 93), and each matched with one control (n = 93). Features assessed at the yearly visits and their changes within the follow-up period were from MRI (cartilage volume, meniscal thickness, bone marrow lesions, bone curvature, and synovial effusion size), X-ray (joint space width), and clinical (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain score) data. Participants who received IACI experienced a transient and significantly greater rate of loss of the meniscal thickness (p = 0.006) and joint space width (p = 0.011) in the knee medial compartment in the year they received the injection, compared to controls. No significant effect of the IACI was found on the rate of cartilage loss nor on any other knee structural changes or WOMAC pain post-treatment. In conclusion, a single IACI in knee OA was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
Highlights
Intra-articular corticosteroid injections (IACI) are commonly used for the treatment of knee osteoarthritis (OA), there is controversy regarding possible deleterious effects on joint structure
As the number of participants who had more than one injection fulfilling the inclusion criteria was very small (n = 10) and some had missing magnetic resonance images (MRI) exam(s) (n = 3) or JSW assessment(s) (n = 6), those participants were excluded because there was not enough information to draw any valid conclusions from a statistical analysis point of view
Data in this study demonstrated that a single intra-articular corticosteroid injections (IACI) in knee OA was safe with no negative impact on articular structural changes, as no differences between the control and IACI groups were found for cartilage volume change, bone curvature, and bone marrow lesion (BML) in the evolution of the structural changes post-treatment
Summary
Intra-articular corticosteroid injections (IACI) are commonly used for the treatment of knee osteoarthritis (OA), there is controversy regarding possible deleterious effects on joint structure In this line, this study investigates the effects of IACI on the evolution of knee OA structural changes and pain. Studies that used the OAI cohort have identified the determinants predicting the response to intra-articular hyaluronic acid (HA) treatment in symptomatic knee OA, as well as the effects of treatment such as SYSADOAs and other drugs used for the symptomatic treatment of OA on the evolution of joint structural changes and disease outcome[15,16,17,18,19,20,21]
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