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Corticosteroid Injections in Joints Accelerate Arthritis

Doctors frequently use corticosteroid injections into joints to ease pain and stiffness. A new review of the evidence suggests this has serious downsides.
A doctor injects a medical injection of chondroprotector and hyaluronic acid into the knee of a woman to restore the knee joint, cartilage and synovial fluid, close-up

When athletes or older people with osteoarthritis develop joint pain, doctors frequently offer corticosteroid injections into the affected joint. Many clinicians have assumed that this treatment is safe. A new analysis published in the journal Radiology (Oct. 15, 2019) calls that assumption into question.

What Happens To Cartilage After Corticosteroid Injections?

The authors of the latest article on this topic title it:

“Intra-articular Corticosteroid Injections in the Hip and Knee:

“Perhaps Not as Safe as We Thought?”

They report that corticosteroid injections into knees and hips may actually accelerate the progression of osteoarthritis in the long run. The medications that are used can cause joint and cartilage destruction.

Another complication is osteonecrosis or death of bone tissue. People who have received such steroid injections may need total joint replacement sooner than expected.

Corticosteroids and Chondrocyte Toxicity:

How do corticosteroid injections do damage? It all starts with chondrocytes. These are the cells that create healthy cartilage and connective tissue. You want happy chondrocytes because these cells are crucial when it comes to repairing damaged joint tissue and regenerating new cartilage.

Guess what? Corticosteroids are “chondrotoxic.” That is to say, the steroid shots make chondrocytes unhappy. The drugs have a negative impact on cartilage production. Cartilage volume decreases.

When radiologists looked at images of knees that got injected with steroids and compared them to knees injected with saline placebos, the results were not pretty. Corticosteroid injections led to worsening of osteoarthritis (Osteoarthritis and Cartilage, June, 2019).

But wait. It gets worse. Corticosteroid injections are often administered with local anesthetics to reduce discomfort. It turns out that the local anesthetics may also be toxic to chondrocytes (Anesthesia and Analgesia, Aug. 2013). 

But Wait, It Gets Even Worse!

A study published in JAMA (May 16, 2017) compared injections of the steroid triamcinolone to saline on knee cartilage volume and pain in patients with knee osteoarthritis. 

The corticosteroid injections did not ease knee pain better than placebo. Even worse, there was “greater cartilage volume loss.” By now, you know that is not a good thing.

Read more about this intriguing study at this link:

Do Treatments for Knee Arthritis Do More Harm Than Good?

Readers Push Back:

We know that many readers report relief from cortisone injections. They “love” their steroid shots. That’s great, as long those injections are kept to a minimum and are not repeated frequently. We see this treatment as a stopgap measure. Patients should be informed by orthopedic physicians that osteoarthritis may get worse faster and that a joint replacement may become necessary sooner.

Share your own experience with corticosteroid injections below in the comment section. We are eager to hear both sides of the story.

You may find our eGuide to Alternatives for Arthritis of interest. It is an electronic resource.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Alternatives for Arthritis
$5.99

This eGuide describes nondrug alternatives for arthritis with the latest scientific studies to document anti-inflammatory activity. This comprehensive online guide (too long to print) adds the science behind ancient healing traditions.

Alternatives for Arthritis
Citations
  • Kompel AJ et al, "Intra-articular corticosteroid injections in the hip and knee: Perhaps not as safe as we thought?" Radiology, Oct. 15, 2019. https://doi.org/10.1148/radiol.2019190341
  • Zeng C et al, "Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative." Osteoarthritis and Cartilage, June, 2019. DOI: 10.1016/j.joca.2019.01.007
  • Breu A et al, "The cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage." Anesthesia and Analgesia, Aug. 2013. DOI: 10.1213/ANE.0b013e31829481ed
  • McAlindon TE et al, "Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial." JAMA, May 16, 2017. doi:10.1001/jama.2017.5283
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But it gives relief, that is sure, but maybe not to all who takes it. So what do you do?? It is not specified how many shots at what interval and the amount taken when compared with placebo. Other related conditions of patient not disclosed. Will one injection or two in year problematic? Not clear.

I have been reading comments but saw nothing about steroid injections into the spine. My husband has had several over the years & is scheduled for another one tomorrow. Are they likely to be causing more harm than good? He is in a lot of pain without them, & sometimes they don’t work.

The review did not address injections into the spine. However, the spine is composed of numerous joints. Very likely the same factors at play in the large joints such as the knee or hip are also relevant in the spine. We will have to wait for research to know for sure, however.

Many years ago I had bursitis, a painful shoulder condition. I ultimately had surgery but first tried the injections. The first one made me faint, but gave me 6 mos. of relief. The second one only gave me 3 mos. The third helped for about a month, so by then, the writing was on the wall. And that was before non-medical people discovered that these treatments aren’t really so great for one’s health.
Ice and over-the-counter pain relief are fine for me now until surgery is available.

At 55 both my knees were getting very painful after working as a licensed massage therapist for nearly 20 years. I was in so much pain at one point I had to have some relief and agreed to “the shots”. I had them in both knees at once, and things went DOWNHILL after that! I should have known better! They never gave me any relief.

I had my left knee “replaced” at age 57, which was 5 YEARS ago, and went to three different PTs trying to get better, to no avail! The PT mentioned how damaging steroid shots are. My knee only bends to 88 degrees, and the surgeon feels that is “sufficient for daily living”! WRONG, it is nowhere near enabling me to live a normal life without pain! PEOPLE, PLEASE BEWARE!

I was getting those shots for about two years or so. They only helped a short time, and I think I did get worse much sooner with the shots. I had to have total knee replacement of both knees.

One shot I completely understand but no more than that. It is proven that repeated injections of steroids will actually break down the joint faster.

I have had two different yet very, very painful injections into the joint at the base of my thumb, with minimal and not long-lasting pain relief. So I’m very interested in this information. The most pain relief I’ve gotten is from forced rest (in a splint) and controlled exercise/movements.

2 decades ago, my mother’s orthopedic surgeon said the rheumatologists are good for their business as their patients always find themselves consulting an orthopedic surgeon for joint replacement due to the destruction of cartilage in the injected joint. I, too, have osteoarthritis but for the last 10 years, have opted to treat mine with daily curcumin supplements. Annual xrays show the destruction of cartilage in my joints has been arrested, and I am pain free with full mobility.

I have arthritis in knee. Dr. Told me if I strengthen the top part of my leg it would help. Well I did not do that. In meantime I got an exercise board to work my midriff. Not aware it would help strengthen the top part of my leg. It did, and now I have no pain. Dr. was right, and no shots.

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