Joint pain. I hear more and more patients tell me how painful their joints are every day. One of the most common treatments for arthritis, corticosteroid injections, may actually increase the progression of the disease, according to new research. Many patients have had steroid injections into their joints, with no relief or maybe temporary relief, and now the injections no longer work. Some tell me that their pain has gotten progressively worse over time. Here is some information on the research that is being shown as to why the condition gets worse after steroid injections.
Osteoarthritis is the most common type of arthritis, especially as we age. It occurs when the cartilage that cushions a joint, breaks down over time, causing pain and stiffness. More than 32 million U.S. adults suffer from this condition, which most often affects the hands, the hips and the knees. There is no cure, but the discomfort is commonly treated with corticosteroid shots. Another pain-relieving injection is Hyaluronic Acid, which is not a steroid. It cushions the degenerated joint, and in many cases, just puts off the inevitable surgery later on.
Two small unpublished studies were recently presented at the Radiological Society of North America’s annual meeting. The studies found that on average, knee arthritis advanced much more quickly in patients who received corticosteroid injections than those who did not.
Both studies evaluated patients from the Osteoarthritis Initiative, a yearslong observational research project involving close to 5,000 people with knee osteoarthritis. The researchers analyzed X-rays from 50 patients who received corticosteroid shots, 50 who received hyaluronic acid and another 50 in a control group. The scans, collected annually for four years, revealed worse arthritis progression among those injected with corticosteroids compared to the other two groups.
The second study, from the University of California, San Francisco, examined MRI scans from 210 participants, 44 who received corticosteroid shots and 26 received hyaluronic acid.
The researchers looked at scans that were taken at the time of the injections, as well as two years before and after, and found more severe cartilage deterioration by the two-year follow-up among the steroid-taking group. The researchers are encouraging patients to make more informed decisions on which injections they receive.
They also agreed that more research is needed, as are peer reviews for their studies.
If you or anyone you know has been receiving corticosteroid injections and would like to have injections that actually help regenerate the cartilage, please call my office for a complimentary consultation.
One rheumatologist at NYU Langone Health, said “It’s tough to determine causation in studies like the two new ones, because many factors can influence the progression of arthritis and no two patients are the same.” “We don’t have the biology to prove that the injection itself is causing accelerated damage.
It’s hard to connect the dots from injection to damage from this preliminary data,” he said. “But it’s an important question, because it’s such a common practice to be injected with steroids.”
One research team did try to control the possibility that people who received steroid injections were perhaps more likely to engage in activities that furthered the progression of their arthritis afterward. As a result, they selected participants who had maintained similar activity levels throughout the study period. Here in Arizona, many patients are quite active, and have a tendency to cause further damage as a result. Being active is important at any age and should not be put on hold because of joint degeneration. I feel it would have been better to study active patients to monitor the degradation of the cartilage over time.
So, to recap, it’s important to know what you are being injected with, and what the repercussions are if a steroid is injected into your joints. Yes, you may feel fast relief, and be able to return to your activities quickly with less pain, but at what cost in the long run? Regenerative treatments are available, and are designed to assist cartilage, not further damage it. PRP, PRF, Ozone, and HCTs, (formerly known as stem cells), may actually get you back to the activities you love, without the degenerative effects and no down time. Regenerative medicine does not treat a condition, it helps the body react and perform the way it was originally meant to.
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Leisa-Marie Grgula. DC
Chiropractic Physician
Accurate Care Medical Wellness Center
18261 N. Pima Rd. Ste. #115
(480) 584-3955
