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Corticosteroid Injections in Joints Accelerate Arthritis

Doctors frequently use corticosteroid injections into joints to ease pain and stiffness. A new review of the evidence suggests this has serious downsides.
Corticosteroid Injections in Joints Accelerate Arthritis
A doctor injects a medical injection of chondroprotector and hyaluronic acid into the knee of a woman to restore the knee joint, cartilage and synovial fluid, close-up

When athletes or older people with osteoarthritis develop joint pain, doctors frequently offer corticosteroid injections into the affected joint. Many clinicians have assumed that this treatment is safe. A new analysis published in the journal Radiology (Oct. 15, 2019) calls that assumption into question.

What Happens To Cartilage After Corticosteroid Injections?

The authors of the latest article on this topic title it:

“Intra-articular Corticosteroid Injections in the Hip and Knee:

“Perhaps Not as Safe as We Thought?”

They report that corticosteroid injections into knees and hips may actually accelerate the progression of osteoarthritis in the long run. The medications that are used can cause joint and cartilage destruction.

Another complication is osteonecrosis or death of bone tissue. People who have received such steroid injections may need total joint replacement sooner than expected.

Corticosteroids and Chondrocyte Toxicity:

How do corticosteroid injections do damage? It all starts with chondrocytes. These are the cells that create healthy cartilage and connective tissue. You want happy chondrocytes because these cells are crucial when it comes to repairing damaged joint tissue and regenerating new cartilage.

Guess what? Corticosteroids are “chondrotoxic.” That is to say, the steroid shots make chondrocytes unhappy. The drugs have a negative impact on cartilage production. Cartilage volume decreases.

When radiologists looked at images of knees that got injected with steroids and compared them to knees injected with saline placebos, the results were not pretty. Corticosteroid injections led to worsening of osteoarthritis (Osteoarthritis and Cartilage, June, 2019).

But wait. It gets worse. Corticosteroid injections are often administered with local anesthetics to reduce discomfort. It turns out that the local anesthetics may also be toxic to chondrocytes (Anesthesia and Analgesia, Aug. 2013). 

But Wait, It Gets Even Worse!

A study published in JAMA (May 16, 2017) compared injections of the steroid triamcinolone to saline on knee cartilage volume and pain in patients with knee osteoarthritis. 

The corticosteroid injections did not ease knee pain better than placebo. Even worse, there was “greater cartilage volume loss.” By now, you know that is not a good thing.

Read more about this intriguing study at this link:

Do Treatments for Knee Arthritis Do More Harm Than Good?

Readers Push Back:

We know that many readers report relief from cortisone injections. They “love” their steroid shots. That’s great, as long those injections are kept to a minimum and are not repeated frequently. We see this treatment as a stopgap measure. Patients should be informed by orthopedic physicians that osteoarthritis may get worse faster and that a joint replacement may become necessary sooner.

Share your own experience with corticosteroid injections below in the comment section. We are eager to hear both sides of the story.

You may find our eGuide to Alternatives for Arthritis of interest. It is an electronic resource.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Alternatives for Arthritis
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This eGuide describes nondrug alternatives for arthritis with the latest scientific studies to document anti-inflammatory activity. This comprehensive online guide (too long to print) adds the science behind ancient healing traditions.

Alternatives for Arthritis
Citations
  • Kompel AJ et al, "Intra-articular corticosteroid injections in the hip and knee: Perhaps not as safe as we thought?" Radiology, Oct. 15, 2019. https://doi.org/10.1148/radiol.2019190341
  • Zeng C et al, "Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative." Osteoarthritis and Cartilage, June, 2019. DOI: 10.1016/j.joca.2019.01.007
  • Breu A et al, "The cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage." Anesthesia and Analgesia, Aug. 2013. DOI: 10.1213/ANE.0b013e31829481ed
  • McAlindon TE et al, "Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial." JAMA, May 16, 2017. doi:10.1001/jama.2017.5283
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