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Study questions benefits of steroid injections for knee arthritis

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A new study suggests that patients get no long-term pain relief from injections of cortisone for knee arthritis. In fact, the treatment was associated with a small amount of cartilage loss over a two-year period.

A research team led by Dr Timothy McAlindon of Tufts Medical Center in Boston conducted a randomised clinical trial of 140 patients with symptomatic knee osteoarthritis. They wanted to determine the effects of intra-articular injection of 40 mg of the corticosteroid triamcinolone acetonide every three months, compared with intra-articular saline, on progression of cartilage loss and knee pain.

“We thought that administering corticosteroids every three months over the long term might reduce inflammation, and at least slow down the progression of the cartilage damage,” Dr McAlindon told WebMD.

However, the results showed that patients receiving the injections of triamcinolone had greater cartilage volume loss than those in the saline group. This illustrates the potential for cartilage loss if corticosteroids are given as a long-term treatment, Dr McAlindon explained.

Additionally, while both groups experienced some relief from pain in the short term, there was no significant difference between the two groups. Physical function also remained about the same in both groups.

“The results of this study do not support the use of long-term, repeated corticosteroid injections for the management of pain or structural progression in osteoarthritis, and in fact indicate that there may be more cartilage loss in people who receive steroids,” Dr McAlindon told CTV News.

But despite the findings, Dr McAlindon believes cortisone injections have a role to play in treating knee arthritis, for example if other choices, such as knee replacement, are not practical. It’s a matter of weighing the risks and benefits, as some patients might decide to risk a small amount of cartilage loss in return for even short-term pain relief.

The study has been published in the Journal of the American Medical Association.