Corticosteroid Injections More Dangerous To Patients Than Previously Thought: Study

According to the findings of a new study, corticosteroid injections may offer temporary relief for joint pain, but individuals may experience serious long-term side effects.

Researchers from Boston University indicate that steroid injections for hip and knee joint pain resulting from osteoarthritis may lead to the need for early joint replacement surgery and other serious side effects, such as early bone loss. The findings were published October 15, in the journal Radiology.

Osteoarthritis is one of the most common joint disorders, often affecting the hips or knees. One common temporary treatment for discomfort, pain, and inflammation is corticosteroid injections, but these injections may not be as safe as doctors thought.

More than 30 million Americans have osteoarthritis, which is a chronic condition that causes cartilage loss, joint inflammation, pain, swelling and in severe cases, bone destruction. Many doctors offer injections as a temporary way to mitigate pain and inflammation, but it is not a long-term treatment.

Historically, studies have shown conflicting evidence about the potential benefit of corticosteroid shots and the possible risks.

Researchers conducted a review of existing literature on osteoarthritis injections and side effects of joint injections. One study focusing on more than 16,500 patients who underwent knee or hip joint replacement indicated more than half of the patients had received corticosteroids injections in the prior two years.

According to the study, complication rates among patients who had corticosteroid shots may be underestimated, since more than 200 of the patients did not have follow-up imaging tests to assess the health or damage of the joints.

Additionally, the team analyzed data on 459 patients at Boston Medical Center who received one to three corticosteroid injections in the hip or knee in 2018. Of those, 8% of patients developed complications within 2-15 months following injections. Complications included cartilage loss, stress fractures, bone deterioration, and joint destruction needing replacement surgery.

The findings suggest that shots to the hips and knees may accelerate the progression of osteoarthritis and speed up the need for joint replacement surgery. The researchers warned that the injections may be more harmful than helpful, since patients report only temporary pain relief from the injections.

Researchers say they do not know why corticosteroids increase problems from osteoarthritis. They speculate perhaps the injections may be toxic to cartilage.

“Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications,” they wrote.

The researchers suggest doctors and their patients discuss using noninvasive approaches to treating osteoarthritis before turning to corticosteroids. Those approaches can include exercise, physical therapy and weight loss, which may help improve pain first.