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Steroid Injections for Osteoarthritis in Knees Don't Work

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A recent study in the Journal of the American Medical Association has shown that intra-articular injections of the corticosteroid, triamcinolone, over 2 years did not decrease knee pain from osteoarthritis any more than injecting saline. In fact, injecting corticosteroid into the knee causes significant cartilage loss. 

In the past, intra-articular triamcinolone knee injections were used because evidence indicated that osteoarthritis and cartilage loss was caused by inflammation. The theory was that steroids would suppress the inflammatory reaction in osteoarthritic knees, might reduce loss of cartilage and slow the progression of osteoarthritis. However, cases were found where intra-articular steroids caused joint injury and a question was raised about the validity of this therapy.

Prior studies looked at osteoarthritis changes on x-ray to determine if intra-articular steroid injections caused any progression or worsening. Unfortunately, x-ray is very insensitive to demonstrating progression of osteoarthritis, and does not show cartilage, soft tissue or marrow lesions. This study used MRI examinations to evaluate the effects of intra-articular steroids on osteoarthritic knees.

The problem with intra-articular steroid injections is that it causes accelerated loss of the hyaline cartilage that lines the knee and allows for frictionless movement. The cartilage covers the bone and, with its loss, bone starts to grind on bone increasing the inflammatory reaction and the development of osteoarthritis. Furthermore, steroid injections did not decrease pain in osteoarthritic knees compared with the placebo saline. Given the lack of benefit, these treatments cause more harm than good and using intra-articular steroids to treat osteoarthritic knees is a form of orthopedic malpractice.

The result of the study was that, among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.

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