Corticosteroid injections and cartilage toxicity introduction As a sports medicine or orthopedic provider, patients often ask about side effects to medications and procedures.
Corticosteroid injections and cartilage toxicity introduction As a sports medicine or orthopedic provider, patients often ask about side effects to medications and procedures. A very frequent question pattern will likely arise and providers should be comfortable answering with an evidence based approach. One of the most common questions that arise with corticosteroid injections are whether or not the corticosteroid injection can wear your knee or cartilage down or if there is a limit to the amount of injections one can get.
Osteoarthritis (OA) is one of the most common chronic and debilitating diseases worldwide, with the knee and the hip being the joints most commonly affected. Intra-articular corticosteroid injections have been used since 1950 to treat arthritis symptoms. Intra-articular injections are especially individuals who cannot tolerate the side-effects of long-term pharmaceutical therapy with acetaminophen and nonsteroidal anti-inflammatory drugs.
An analysis of the Medicare sample database found that more than one-third of patients with newly diagnosed knee OA were treated with at least one intra-articular corticosteroid injection. Although its exact mechanism of action remains unknown, intra-articular corticosteroid injection (CSI or IACs) is thought to provide pain relief in patients with knee and hip OA by decreasing joint inflammation. Although its exact mechanism of action remains somewhat unknown, CSIs are thought to provide pain relief in patients with knee and hip OA by decreasing joint inflammation.
Short-term complications, including septic arthritis, injection site pain or joint flare, skin pigmentation, and atrophy, and systemic effects are very rare. While meta-analyses have reported IACs may be beneficial in relieving pain, at least for a short period of time (up to 6 weeks after IACs), recommendations of its use in management of knee OA varies. For example, the Osteoarthritis Research Society International (OARSI), the American College of Rheumatology (ACR), and the National Institute for Health and Care Excellence (NICE) recommended or conditionally recommended IACs for patients with knee OA.
However, the American Academy of Orthopaedic Surgeons (AAOS) did not reach a conclusion on its use for the management of knee OA. Because of limited high-quality clinical data, even the American Academy of Orthopedic Surgeons does not support an evidence-based recommendation that intra-articular corticosteroid injection is an appropriate treatment option for knee and hip OA. While previous in vivo studies have reported a detrimental effect of IACs on cartilage, there is a paucity of data of the effect of CSIs on joint structure changes among patients with knee OA.
If you are experiencing symptoms that may be related to corticosteroid injections and cartilage toxicity, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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