Corticosteroid Injections May Worsen Knee OA Progression

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Corticosteroid Injections May Worsen Knee OA Progression

Corticosteroid (CS) injections may worsen progression of knee osteoarthritis (OA) as seen on radiography and whole-knee MRI. Injecting hyaluronic acid (HA) instead, or managing the condition without injections, may better preserve knee structure and cartilage, according to results of two related studies presented at the Radiological Society of North America (RSNA) 2022 Annual Meeting.

The findings come nonrandomized, observational cohort studies, leading knee OA experts to call for further study in randomized trial settings. In the meantime, shared decision-making between patients and clinicians is advised on the use of these injections.

For knee OA, most patients seek a noninvasive treatment for symptomatic relief. “At least 10% of these patients undergo local treatment with injectable corticosteroids or hyaluronic acid,” the lead author of one of the studies, Upasana Upadhyay Bharadwaj, MD, research fellow in musculoskeletal radiology at the University of California, San Francisco, said in a video press release.

The researchers semiquantitatively graded three Tesla MRI scans that had been obtained at baseline, 2 years before the injection, and 2 years after the injection, using whole-organ MRI score (WORMS) for the meniscus, bone marrow lesions, cartilage, joint effusion, and ligaments.

At 2 years, the authors found the following:

  • There was a significant association between CS injection and postinjection progression of WORMS over 2 years for the knee overall, the lateral meniscus, lateral cartilage, and medial cartilage.

  • There was no significant link between HA injection and postinjection progression of WORMS.

  • There was no significant link between either injection type and progression of pain, as quantified by WOMAC. [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)]

  • There was no significant difference in progression of WORMS over the 2 years prior to injection for CS and HA injections.

The fact that both studies used the same data and came to the same conclusions gives the conclusions some strength, he said, but “the gold standard to understanding causation would be a randomized, controlled trial.”


Radiological Society of North America (RSNA) 2022 Annual Meeting.

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