Are Cortisone Injections Good or Bad for Arthritic Knees?

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By Dennis Thompson
HealthDay Reporter

TUESDAY, Dec. 21, 2021 (HealthDay News) -- Cortisone injections person gotten a atrocious rap successful caller years arsenic a attraction for arthritis pain, due to the fact that steroids are known to harm cartilage and could perchance origin the associated to further deteriorate.

But a caller survey suggests that if utilized wisely, cortisone shots are arsenic harmless arsenic different benignant of injection utilized to dainty knee arthritis.

Occasional cortisone shots don't look to origin knees to deteriorate immoderate faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.

"Knee replacement rates were, if anything, a small spot little successful the radical that got the cortisone injections," said elder researcher Dr. David Felson, a prof of medicine and epidemiology astatine Boston University School of Medicine.

However, Felson added that the survey lone looked astatine radical who'd gotten infrequent cortisone shots to their knee, and shouldn't beryllium interpreted arsenic giving the greenish airy to regular injections for years to come.

"What we cognize from the survey that we tin spot is that a fewer cortisone injections won't truly origin overmuch trouble," Felson said. "It's conceivable that repeated injections each 3 months for years won't origin immoderate trouble, but you can't accidental that."

Steroids are known to beryllium toxic to cartilage, the connective insubstantial that keeps your bones from rubbing against each other, explained Dr. Melissa Leber, manager of the Emergency Department's Division of Sports Medicine successful the Icahn School of Medicine astatine Mount Sinai successful New York City.

"If you usage it enough, it volition harm the cartilage," said Leber, who had nary relation successful the study.

A 2019 survey reported a threefold accrued risk of genu arthritis progression successful radical who'd received repeated cortisone injections, compared with radical who'd ne'er gotten the shot, Felson and his colleagues said successful inheritance notes.

Comparing 2 types of shots

However, nary clinical trials had ever compared the 2 astir communal types of genu arthritis injections, cortisone jabs and hyaluronic acerb shots, Felson said.

The 2 types of shots bash antithetic things successful the joint, and are sometimes utilized successful combination, Leber said.

Cortisone shots are anti-inflammatory and assistance trim pain, portion hyaluronic acerb injections are similar a gel that provides lubrication successful the ailing joint.

"You're injecting WD40 astir into the knee. That acts to let smoother gliding successful the joint," Leber explained.

Unlike cortisone, hyaluronic acerb gel isn't harmful to cartilage.

The latest survey looked astatine astir 800 radical with genu arthritis, of whom 4 retired of 5 reported getting cortisone shots for their genu pain. The remainder had reported receiving hyaluronic acerb injections.

After 7 years of follow-up, researchers recovered that those who got steroid injections had nary greater cartilage nonaccomplishment than those treated with hyaluronic acid.

In fact, radical who got cortisone shots were astir 25% little apt to request a full genu replacement than those who got hyaluronic acid.

The connection to genu arthritis patients regarding cortisone shots is simple, Felson said: "Don't beryllium scared."

"There's thing atrocious that's going to hap with 1 changeable oregon adjacent a fewer shots," Felson said. "People should beryllium reassured. They shouldn’t debar getting an effectual treatment."

Wise usage is crucial

The findings bolster the attack orthopedic specialists already instrumentality successful handing retired cortisone shots to dainty genu arthritis, Leber said.

"If idiosyncratic already has a ton of harm to the cartilage successful their knee, a batch of arthritis, past we don't interest arsenic overmuch astir utilizing a steroid to assistance with symptom power due to the fact that they already person a batch of arthritis successful the knee," Leber said. "Damaging it a interaction much conscionable to springiness them bully symptom power is simply a precise insignificant thing. It's not arsenic risky.

"In idiosyncratic who's young, successful their 20s to 40s, who has precise small cartilage harm but has pain, we effort to usage it sparingly," she continued. "Would you usage them connected juncture successful a young person? Yes. That's lone arsenic a one-time thing. You don't privation to usage it repetitively.

"Steroid is atrocious for cartilage, but that doesn't mean it's atrocious for each patient," Leber concluded. "It's a case-by-case situation."

Regardless, you wouldn't expect immoderate diligent to person predominant cortisone injections, immoderate their condition, added Dr. Jeffrey Schildhorn, an orthopedic surgeon with Lenox Hill Hospital successful New York City.

"If you springiness idiosyncratic a changeable successful January and they travel backmost successful April saying they privation different one, and they travel backmost successful August and privation different one, however good are they working?" said Schildhorn, who was not portion of the study. "They're not working, if you're lone getting 2 oregon 3 months of relief."

The caller survey was published precocious successful the diary Arthritis and Rheumatology.

More information

The Cleveland Clinic has much astir knee arthritis.

SOURCES: David Felson, MD, professor, medicine and epidemiology, Boston University; Melissa Leber, MD, director, Emergency Department's Division of Sports Medicine, Icahn School of Medicine astatine Mount Sinai, New York City; Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; Arthritis and Rheumatology, Dec. 1, 2021

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