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Steroid injections to knee and hips can relieve pain but may cause damage. Getty Images
  • A new study finds that corticosteroid shots may accelerate arthritis in knee and hip joints, even as it removes pain.
  • Osteoarthritis affects more than 30 million adults in the United States.
  • Corticosteroid shots are widely used to reduce inflammation and lessen pain in knee and hip joints.

Osteoarthritis affects more than 30 million adults in the United States. It causes chronic joint pain, stiffness, and swelling that can make it difficult for people to get around and take part in everyday activities.

In cases when lifestyle changes and oral medications aren’t enough, doctors often prescribe corticosteroid injections to treat painful knees or hips.

But according to a new report published in the journal Radiology, corticosteroid injections may be more damaging for the joint than previously thought.

When the authors reviewed the outcomes of patients who received corticosteroid shots to the knee or hip at their clinic in 2018, they found that 36 out of 459 of those patients were later diagnosed with new or worsened joint problems.

The authors also cited evidence from past studies that have found risks associated with corticosteroid shots.

“I think this study is of importance to healthcare professionals and patients, because we always want to be aware of the risk and benefit of everything that we do,” Dr. Antonia Chen, use criteria leader for the American Academy of Orthopaedic Surgeons’ Evidence-Based Quality and Value Committee, told Healthline.

“[Corticosteroid injections] can be beneficial, but they can also be harmful, as this report highlights,” Chen, who wasn’t involved in the new study, added.

The authors of the new report identified several potential complications that may be associated with corticosteroid injections. These complications may eventually cause joints to collapse, which requires joint replacement surgery to treat.

After receiving corticosteroid injections, some patients at the authors’ clinic developed rapidly progressive osteoarthritis. This happens when an arthritis-affected joint deteriorates more quickly than usual.

Some patients who’d been treated with corticosteroid shots were later diagnosed with a type of stress fracture known as a subchondral insufficiency fracture. Some were diagnosed with complications from osteonecrosis, which happens when bone tissue dies.

It’s possible that these joint issues might have started to develop before the patients received corticosteroid shots. For example, some patients might have had an undiagnosed subchondral insufficiency fracture before they received the shot.

But it’s also possible that corticosteroid injections might have contributed to the development of these issues. If that’s the case, the potential risks of corticosteroid injections may be greater than some people realize.

To learn if and how corticosteroid injections affect the risk of rapidly progressive osteoarthritis, subchondral insufficiency fractures, and complications from osteonecrosis, more research is needed.

“These types of association studies are hypothesis generators, they’re not cause-and-effect provers,” Dr. Matthew Hepinstall, associate director of the Center for Joint Preservation and Reconstruction at Lenox Hill Hospital in New York City, told Healthline.

“Providers need to study it in a more rigorous way with what’s called a randomized controlled clinical trial, where people are randomly assigned to get [corticosteroid injections] or nothing,” he added.

In the meantime, the authors of the new report would like doctors to tell their patients about these potential risks before providing corticosteroid injections.

“It’s good to bring these things to light and have frank discussions with patients about it,” Chen said.

“I do have a risk-benefit talk about it before giving an injection so the patient can make an informed decision about whether or not they want to receive the injection or not,” she added.

In some cases, patients may still decide that the potential benefits of corticosteroid injections outweigh the potential risks for them.

Some patients find that corticosteroid injections provide short-term relief from osteoarthritis-associated pain. Others don’t experience the same benefits.

Corticosteroid injections aren’t the first-line treatment for osteoarthritis.

When people are first diagnosed with osteoarthritis, their doctors often encourage them to make lifestyle changes to help manage their symptoms.

For example, avoiding activities that cause pain, incorporating low-impact exercise into their routine, and losing excess weight may help many people with this condition limit their symptoms and improve their mobility.

“These lifestyle changes are the safest treatments for arthritis. They carry not just very little risk, but also side health benefits,” Hepinstall said.

Doctors may also advise their patients to take oral pain relievers, including over-the-counter or prescription medication. Some of those medications pose a risk of side effects.

If lifestyle choices and oral pain relievers aren’t enough to manage their symptoms, doctors may talk to patients about the potential benefits and risks of injectable medications, including corticosteroids.

When other treatments have failed to provide lasting relief, doctors may recommend joint replacement surgery or other surgical procedures.