Are Cortisone Injections Good or Bad for Arthritic Knees?

By Dennis Thompson
HealthDay Reporter

TUESDAY, Dec. 21, 2021 (HealthDay News) — Cortisone injections have gotten a foul rap in recent times as a remedy for arthritis ache, as a result of steroids are identified to wreck cartilage and will probably trigger the joint to additional deteriorate.

But a brand new research means that if used properly, cortisone pictures are as secure as one other sort of injection used to deal with knee arthritis.

Occasional cortisone pictures do not seem to trigger knees to deteriorate any quicker than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers mentioned.

“Knee alternative charges have been, if something, a bit of bit much less within the group that obtained the cortisone injections,” mentioned senior researcher Dr. David Felson, a professor of medication and epidemiology at Boston University School of Medicine.

However, Felson added that the research solely checked out individuals who’d gotten rare cortisone pictures to their knee, and should not be interpreted as giving the inexperienced mild to common injections for years to come back.

“What we all know from the research that we are able to belief is that a number of cortisone injections will not actually trigger a lot bother,” Felson mentioned. “It’s conceivable that repeated injections each three months for years will not trigger any bother, however you may’t say that.”

Steroids are identified to be poisonous to cartilage, the connective tissue that retains your bones from rubbing towards one another, defined Dr. Melissa Leber, director of the Emergency Department’s Division of Sports Medicine within the Icahn School of Medicine at Mount Sinai in New York City.

“If you utilize it sufficient, it is going to injury the cartilage,” mentioned Leber, who had no position within the research.

A 2019 research reported a threefold elevated threat of knee arthritis development in individuals who’d obtained repeated cortisone injections, in contrast with individuals who’d by no means gotten the shot, Felson and his colleagues mentioned in background notes.

Comparing two varieties of pictures

However, no scientific trials had ever in contrast the 2 commonest varieties of knee arthritis injections, cortisone jabs and hyaluronic acid pictures, Felson mentioned.

The two varieties of pictures do various things within the joint, and are generally utilized in mixture, Leber mentioned.

Cortisone pictures are anti-inflammatory and assist scale back ache, whereas hyaluronic acid injections are like a gel that gives lubrication within the ailing joint.

“You’re injecting WD40 nearly into the knee. That acts to permit smoother gliding within the joint,” Leber defined.

Unlike cortisone, hyaluronic acid gel is not dangerous to cartilage.

The newest research checked out practically 800 individuals with knee arthritis, of whom 4 out of 5 reported getting cortisone pictures for his or her knee ache. The relaxation had reported receiving hyaluronic acid injections.

After seven years of follow-up, researchers discovered that those that obtained steroid injections had no better cartilage loss than these handled with hyaluronic acid.

In truth, individuals who obtained cortisone pictures have been about 25% much less prone to want a complete knee alternative than those that obtained hyaluronic acid.

The message to knee arthritis sufferers concerning cortisone pictures is straightforward, Felson mentioned: “Don’t be scared.”

“There’s nothing unhealthy that is going to occur with one shot or perhaps a few pictures,” Felson mentioned. “People ought to be reassured. They shouldn’t keep away from getting an efficient remedy.”

Wise use is essential

The findings bolster the method orthopedic specialists already soak up handing out cortisone pictures to deal with knee arthritis, Leber mentioned.

“If somebody already has a ton of harm to the cartilage of their knee, plenty of arthritis, then we do not fear as a lot about utilizing a steroid to assist with ache management as a result of they have already got plenty of arthritis within the knee,” Leber mentioned. “Damaging it a contact extra simply to present them good ache management is a really minor factor. It’s not as dangerous.

“In somebody who’s younger, of their 20s to 40s, who has little or no cartilage injury however has ache, we attempt to use it sparingly,” she continued. “Would you utilize them occasionally in a youngster? Yes. That’s solely as a one-time factor. You do not wish to use it repetitively.

“Steroid is unhealthy for cartilage, however that does not imply it is unhealthy for each affected person,” Leber concluded. “It’s a case-by-case state of affairs.”

Regardless, you would not anticipate any affected person to obtain frequent cortisone injections, no matter their situation, added Dr. Jeffrey Schildhorn, an orthopedic surgeon with Lenox Hill Hospital in New York City.

“If you give somebody a shot in January and so they come again in April saying they need one other one, and so they come again in August and wish one other one, how properly are they working?” mentioned Schildhorn, who was not a part of the research. “They’re not working, if you happen to’re solely getting two or three months of reduction.”

The new research was printed not too long ago within the journal Arthritis and Rheumatology.

More info

The Cleveland Clinic has extra about knee arthritis.

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