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Common injections used to treat knee arthritis can make it worse

The discovery is based on two studies involving 360 patients in the US with painful and stiff knees.

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fitness, healthcare and medicine concept - close up of female hands holding knee
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By Mark Waghorn via SWNS

Common steroid injections used to treat osteoarthritis actually make the crippling condition worse, according to new research.

Cortisone jabs speed up degeneration of cartilage - making knee or hip replacement surgery more likely.

They relieve pain but speed up the progression of the disease, scientists say. The discovery is based on two studies involving 360 patients in the US with painful and stiff knees.

Hyaluronic acid - found in moisturizers, lip fillers and beauty creams - was found to be a more effective alternative.

Lead author Dr. Upasana Upadhyay Bharadwaj, of the University of California, San Francisco, said: "Both corticosteroid and hyaluronic acid injections are reported to help with symptomatic pain relief for knee osteoarthritis.

"Our results conclusively show corticosteroids are associated with significant progression of knee osteoarthritis up to two years post-injection and must be administered with caution.

"Hyaluronic acid, on the other hand, may slow down progression of knee osteoarthritis and alleviate long-term effects while offering symptomatic relief."

An older man sits on the floor with his hands on his painful knees.
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His team looked at 210 patients of whom 44 were given corticosteroids, 26 hyaluronic acid and the remaining 140 had no injections at all.

The treatment and control groups were matched by age, sex, body mass index, pain and physical activity scores, and severity of the disease.

An analysis showed corticosteroid knee injections were significantly associated with the overall progression of osteoarthritis in the knee.

This was not the case with the hyaluronic acid group. Compared to the controls they showed a decreased progression of osteoarthritis - specifically in bone marrow lesions.

Dr. Upadhyay Bharadwaj said: "This is the first direct comparison of corticosteroid and hyaluronic acid injections using the semi-quantitative, whole organ assessment of the knee with MRI."

Magnetic resonance imaging (MRI) was performed on all patients at the time of the injection and two years before and after.

The second study included 50 patients who received corticosteroids, 50 hyaluronic acid and another 50 who were not injected.

The former group had significantly more osteoarthritis progression including narrowing of the space in the medial joint - a hallmark of the disease.

Lead author Azad Darbandi, a student at Chicago Medical School said: "While these injections provide some patients with short-term pain relief, the effects of the injections on the progression of the disease are unknown.

Patients underwent X-ray imaging of the knee at the outset and again two years later.

Darbandi said: "Even though imaging findings for all patients were similar at baseline, the imaging hallmarks of osteoarthritis were worse two years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all.

"The results suggest that hyaluronic acid injections should be further explored for the management of knee osteoarthritis symptoms, and that steroid injections should be utilized with more caution."

Osteoarthritis blights the lives of around 8.5 million people in the UK. It is the most common form of arthritis - affecting more than 500 million worldwide.

It occurs most frequently in the hands, hips and knees. In patients, the cartilage that cushions the joint gradually wears away.

Arthritis is often accompanied by inflammation, or swelling, of the joint, which can be painful.

Added Dr. Upadhyay Bharadwaj: "Knowing the long-term effects of these injections will help osteoarthritis patients and clinicians make more informed decisions for managing the disease and the pain it causes."

The results were presented at a Radiological Society of North America meeting in Chicago.

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