Corticosteroid knee injections could be associated with greater structural damage in patients with osteoarthritis compared with hyaluronic acid injections and no injections, according to a study .
In a national longitudinal study, investigators analyzed magnetic resonance imaging (MRI) scans from 210 participants aged 45 to 79 years. Each participant received either a single corticosteroid injection, a single hyaluronic acid (HA) injection, or no injection. The investigators evaluated joint changes using the Whole-Organ MRI Score (WORMS), which assesses cartilage loss, bone damage, and meniscal integrity.
Participants who received corticosteroid injections showed greater increases in WORMS scores over 2 years, indicating more joint degeneration. Cartilage deterioration was more pronounced in the corticosteroid group compared with both the HA group and the no-injection control group. The mean difference in the WORMS score between the corticosteroid and control groups was 0.39, and 0.42 compared with the HA group—both statistically significant.
HA injections were associated with slower joint progression. WORMS scores were lower 2 years following HA injections compared with the 2 years prior to injection, suggesting that HA may reduce the rate of structural deterioration in the short term.
Both injection types were linked to pain relief. Pain levels were measured using the Western Ontario and McMaster Universities Osteoarthritis Index. Participants who received corticosteroid injections experienced the largest reductions in pain scores followed by those who received HA. Pain improvements were statistically significant in both groups.
To minimize bias, the investigators applied matching techniques to compare participants of similar age, body mass index, physical activity levels, and baseline knee condition. MRI scans were reviewed at three intervals: 2 years prior to the injection, at the time of injection, and 2 years following injection. Only participants with a single reported injection were included to isolate the effects of one treatment.
Although the investigators didn't establish causation between injection type and structural changes, they identified differences in outcomes between corticosteroids and HA. Corticosteroids, while effective for short-term pain relief, were linked to more joint deterioration. HA, though less potent in pain reduction, was associated with reduced cartilage damage.
The investigators acknowledged limitations, including reliance on self-reported injection history and the potential for unmeasured confounding variables. They recommended further investigation through randomized clinical trials with imaging-based outcomes.
The findings contributed to the ongoing evaluation of intra-articular injections for osteoarthritis and offered imaging evidence to inform clinical decision-making.
The authors reported no conflicts of interest.
Source: Radiology
