In The Bone & Joint Journal, RIHS researcher Stan Wijn et al. showed that patients with, or at risk of developing, symptomatic osteoarthritis of the knee were 1.57x more likely to undergo knee arthroplasty surgery after each corticosteroid injection they received in the knee joint.
Their findings were in line with previous studies that found a harmful effect of corticosteroid and suggest that a conservative approach regarding the treatment of these patients with corticosteroid injections should be recommended. The Bone and Joint Journal made a short clip of their findings and their publication got a lot of social media attention.
Recent studies have suggested that corticosteroid injections into the knee may harm the joint resulting in cartilage loss and possibly accelerating the progression of osteoarthritis (OA). The aim of this study was to assess whether patients with, or at risk of developing, symptomatic osteoarthritis of the knee who receive intra-articular corticosteroid injections have an increased risk of requiring arthroplasty.
We used data from the Osteoarthritis Initiative (OAI), a multicentre observational cohort study that followed 4,796 patients with, or at risk of developing, osteoarthritis of the knee on an annual basis with follow-up available up to nine years. Increased risk for symptomatic OA was defined as frequent knee symptoms (pain, aching, or stiffness) without radiological evidence of OA and two or more risk factors, while OA was defined by the presence of both femoral osteophytes and frequent symptoms in one or both knees. Missing data were imputed with multiple imputations using chained equations. Time-dependent propensity score matching was performed to match patients at the time of receving their first injection with controls. The effect of corticosteroid injections on the rate of subsequent (total and partial) knee arthroplasty was estimated using Cox proportional-hazards survival analyses.
After removing patients lost to follow-up, 3,822 patients remained in the study. A total of 249 (31.3%) of the 796 patients who received corticosteroid injections, and 152 (5.0%) of the 3,026 who did not, had knee arthroplasty. In the matched cohort, Cox proportional-hazards regression resulted in a hazard ratio of 1.57 (95% confidence interval (CI) 1.37 to 1.81; p < 0.001) and each injection increased the absolute risk of arthroplasty by 9.4% at nine years' follow-up compared with those who did not receive injections.
Corticosteroid injections seem to be associated with an increased risk of knee arthroplasty in patients with, or at risk of developing, symptomatic OA of the knee. These findings suggest that a conservative approach regarding the treatment of these patients with corticosteroid injections should be recommended.
Intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty.
Wijn SRW, Rovers MM, van Tienen TG, Hannink G.
Related news items
Frank Walboomers 25-years work anniversary at Radboudumc17 September 2020
Frank Walboomers, associate professor at the research group Regenerative Biomaterials at the Dept. of Dentistry (theme Reconstructive & Regenerative Medicine), celebrated his 25th work anniversary at Radboudumc.read more
Tjitske Kleefstra appointed endowed professor of Clinical genetics and psychopathology of rare syndromes17 September 2020
Tjitske Kleefstra has been appointed endowed professor of Clinical genetics and psychopathology of rare syndromes at the department of Neurodevelopmental disorders, with effect from 1 September.read more
Annette Schenck appointed professor of Translational Genetics17 September 2020
Annette Schenck has been appointed professor of Translational Genetics at the department of Neurodevelopmental disorders, with effect from 1 August. The chair will bring together fundamental and translational research in the field of brain developmental disorders.read more
Centuries-old medicine reduces the risk of new cardiovascular disease in heart patients17 September 2020
Colchicine, an anti-inflammatory drug that has been used for gout for centuries, has been shown to prevent cardiovascular disease in patients who have had a heart attack or are suffering from narrowed coronary arteries. Results of the study are published in the New England Journal of Medicine.read more
Radboudumc does large-scale research on systemic sclerosis10 September 2020
In rare diseases, such as systemic sclerosis, it’s often difficult to conduct large-scale research. Rheumatologist Madelon Vonk has managed to follow enough patients with systemic sclerosis for years. The results of her research have been published in BMJ Annal of the Rheumatic Diseases.read more