Steroid shots are the go-to treatment for people with painful knee arthritis. Patients typically receive injections of corticosteroid drugs directly into the knee joint every few months at an outpatient clinic.
However, a new study has found that steroid shots do not work any better than salt-water, and they may actually worsen cartilage loss.
The researchers randomly assigned 140 men and women over 45 years old to receive injections of either salt-water or a steroid shot. The patients were injected every 12 weeks for two years.
All of the patients had knee arthritis with inflammation of the synovial membrane, making them ideal patients for treatment with the anti-inflammatory corticosteroid triamcinolone.
At the end of the study, there was no overall difference between the two groups in terms of pain, stiffness, ability to stand from a seated position, or walk. Bone and joint scans also showed no differences.
The only major difference was that patients who got steroid shots had twice the amount of cartilage loss in their knees — 0.21 millimeters for the steroid shot group, vs. 0.10 millimeters for the salt-water group.
The results were surprising because the researchers thought steroid shots might reduce inflammation, or at least slow down the progression of cartilage damage. Instead, they found steroid shots had the opposite effect.
Dr. Timothy E. McAlindon, chief of rheumatology at Tufts Medical Center in Boston, Massachusetts, said steroid shots may be useful for treating short-term pain associated with flareups of arthritis, but not as a long-term treatment strategy:
There’s a lot of excitement about treating inflammation to influence this disease, but this study is a test of that notion, and it’s negative. So we really have to question whether it’s correct.”
Osteoarthritis, also known as degenerative joint disease, affects 30 million adults in the United States. It is caused by the breakdown of cartilage, which is the pad of tissue between the knee bones. It is extremely painful when the bones scrape together.
Steroid shots temporarily relieve pain, but the effects wear off in about two months. The long-term trade-off is faster degeneration of cartilage in the knees and progressive joint damage.
Source: Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis — JAMA (May 2017)