Are steroid injections into your joints doing you more harm than good?

The Radiological Society of North America recently published a study that found corticosteroid knee injections could be making knee osteoarthritis worse.

What can we learn from this study and how can you best manage osteoarthritis without injections?

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In this article

• What is osteoarthritis?
• What is a corticosteroid injection?
• The study
• Should you think again about injections?
• How should you manage osteoarthritis?
• Do you qualify for HBF's osteoarthritis treatment programs?

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What is osteoarthritis?

Osteoarthritis is one of the most common diseases of the joint affecting the hip and knee joints.

The affected joint becomes inflamed and damaged, so over time the bones in the joint will rub together causing more pain, swelling, stiffness, and reduced movement. ¹

What is a corticosteroid injection and why are people having them?

These are the main reasons we know people choose to have a corticosteroid injection - and when they should be considered:

• To help relieve pain and inflammation in a specific area of the body.
• Known to be most effective in treating inflammatory conditions such as osteoarthritis, bursitis, gout, and tendonitis²
• Used for pain when you’ve got an impending joint replacement
• Can be used to help manage pain during acute flare-ups of osteoarthritis.

They should only be considered after conservative methods of treatment have failed e.g. oral pain relief or anti-inflammatory medications, exercise and physiotherapy.

The study

In this study magnetic resonance imaging (MRI) was used to assess the degree of knee osteoarthritis and the results suggested that steroid injections led to a progression of osteoarthritis - on both the inner and outer sides of the knee. It also showed that hyaluronic acid injections were not associated with the progression of osteoarthritis.¹

This isn’t the first study to look at whether corticosteroid injections are causing more harm than good. A 2019 study identified some adverse events associated with these types of injections including osteoarthritis progression when compared to the control group.³

Should you think again about having these injections?

The Royal Australian College of General Practitioners (RACGP) has voiced concerns of more rapid cartilage loss with repeated injections, with no benefit in long-term symptom outcomes at two years. They advise that these injections be used cautiously and only for short-term pain relief for hip or knee osteoarthritis.⁴

An injection of corticosteroid medication into the joint during a ‘flare’ can provide short-term pain relief (usually for two to four weeks) and help you return to an exercise program or normal activity.⁵

Tips for managing your osteoarthritis

Although there’s no cure for osteoarthritis, there are many options both surgical and non-surgical to help you manage the symptoms.

The Australian Commission on Safety and Quality in Health Care have developed a guide to help you discuss the main treatment options for osteoarthritis of the knee with your doctor.

Also consider:

• Health Support Programs – HBF offer three programs to eligible members to help you manage your osteoarthritis and aim to prevent or delay your need for a hip or knee replacement: The GLA:D Program, Healthy Weight for Life and Stand Up to Joint Pain.
• Regularly exercise – keeps your muscles and joints healthy and flexible.
• Maintain a healthy weight – extra body weight increases stress on the joints in particularly the hips and knees, achieving a healthy weight will help to reduce the impact of your joints.
• Aids & supports – though the evidence is limited, walking sticks, taping the joint, braces or using shoe insoles (orthoses) may help to improve your body alignment when standing and walking. Talk to your physiotherapist.
• Pain management medicines – Oral non-steroidal anti-inflammatory medicines (NSAIDs) can help reduce osteoarthritis pain, swelling and stiffness. Check with your doctor or pharmacist to see if these are suitable for you, as NSAIDs have many potential side effects, such as stomach ulcers and bleeding, heart and kidney problems.
• Surgery – a joint replacement involves removing bone from around the joint and replacing it with metal, ceramic, or plastic parts.

Final note: Speak to your doctor about the treatment options to develop a shared management plan which takes into account the severity of your symptoms and your preference.