Be Cautious about Your First Treatment Choice for Arthritis
Advanced Back and Neck Care • May 23, 2024
A common therapy for joint pain may not be as safe as experts believed, according to a new report published Tuesday.
Corticosteroid injections are often given to reduce pain and inflammation from osteoarthritis.
But these injections may do more harm than good: The report found corticosteroid shots in the hips and knees may accelerate the progression of osteoarthritis and potentially even hasten the need for joint replacement surgeries in the long run, said lead author Dr. Ali Guermazi, a professor of radiology at the Boston University School of Medicine.
“The intra-articular corticosteroid injections in the hips and knees are not as safe as we thought,” Guermazi, whose paper is published in the journal Radiology, said.
It’s estimated that more than 30 million Americans have osteoarthritis, a chronic condition that causes cartilage loss, joint inflammation, pain, swelling and, in severe cases, bone destruction, according to the Arthritis Foundation.
Corticosteroid injections into the hips and knees are a common treatment for patients in significant pain; in one study of more than 16,500 patients who underwent knee or hip joint replacement, half had received corticosteroid injections in the prior two years. The injections often are covered by insurance.
In the new paper, Guermazi’s team reviewed existing literature on corticosteroid injections for osteoarthritis, and also looked at data on 459 patients at Boston Medical Center who received one to three corticosteroid injections in the hip or knee in 2018. The researchers found that 8 percent of patients developed complications, including cartilage loss, stress fractures, bone deterioration and joint destruction, in the two to 15 months following the injections.
The rate of complications surprised Guermazi, who added that the figure may actually be an underestimate, because 218 of the patients did not have follow-up imaging tests to assess the health of their joints.
While patients may report temporary pain relief from the corticosteroid injections, he said, the injections may be detrimental in the long run. “They may actually harm your knee or your hip,” he said.
An exact explanation for the findings is unclear, Guermazi said, but there is some evidence that corticosteroid injections, which typically are combined with an anesthetic, can be toxic to cartilage, and more studies are needed to understand their effects and clarify their benefits and risks.
Dr. Antonia Chen, an associate professor of orthopaedic surgery at Harvard Medical School and a spokesperson for the American Academy of Orthopedic Surgeons, said corticosteroid injections can help relieve pain in some, but not all, patients for as long as days or months. But patients should be informed that the injections carry risks, as the new paper and others have shown, which is why it’s recommended the injections be given no more frequently than every three months, she said.
“There are definitely benefits and there are definitely risks, and these risks must be mentioned to patients,” Chen said. “Some patients will say they don’t want to undergo temporary relief and they don’t want to have the chance of progressing their arthritis, and some say they need some sort of pain relief to just live day to day.”
But before turning to injections or other medications, Chen recommends that patients with osteoarthritis first talk with a physician about noninvasive approaches, such as exercise, physical therapy and weight loss.
Guy Eakin, senior vice president of scientific strategy for the Arthritis Foundation, agreed, telling NBC News that a healthy lifestyle remains the key to managing osteoarthritis.
“Exercise is really one of the best things that can be done,” he said.
Indeed, research indicates that exercise helps ease pain, improve mobility and strengthen muscles around the joints. Stretching activities such as yoga and tai chi may help increase flexibility and reduce joint stiffness. Exercise also can aid in weight loss to reduce pressure on the joints.
While arthritis patients in chronic pain may try to get relief from pain relievers or injections of corticosteroids or hyaluronic acid, there is no cure for the condition. Patients who ultimately end up with bone rubbing against bone may be in such severe pain and have such difficulty moving that they opt for a total joint replacement.
By Jacqueline Stenson
: NBC News contributor Jacqueline Stenson is a health and fitness journalist who has written for the Los Angeles Times, Reuters, Health, Self and Shape, among others. She also teaches at the UCLA Extension Writers’ Program.
Originally posted on January 30,2023, this article has been updated on August 24, 2024 to reflect the latest research and statistics. Our editorial team has ensured you’re viewing the most current data on this topic. Need help or have a question? Email us.
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At the very least, you'll want to keep this to a minimum. Inflammation is often visible—think red skin or a swollen knee. However, inflammation can also occur on the inside, and it's not always so easy to detect. "Inflammation is a physiological process involved in the defense of our body and the repair of tissues," says Jenna Stangland, RD , a Momentous advisor. Stangland explains that inflammation can be triggered by infections, trauma, toxins or allergic reactions. Sometimes, it becomes chronic in the muscles and tissues. Unfortunately, Stangland says chronic inflammation carries risks. "Chronic inflammation can end up stimulating the development of cardiovascular diseases, autoimmune disease, neurological disease or cancer," Stangland says. "This type of inflammation can last several months as a result of inability to combat and reduce it." Diet isn't a cure-all for chronic inflammation or the diseases it can trigger. However, it's an important tool. "Diet plays a significant role in inflammation, as certain foods can either promote or reduce inflammation in the body," says Michelle Routhenstein, MS, RD, CDCES, CDN , a preventive cardiology dietitian at EntirelyNourished.com . One food in particular is worth avoiding. RDs shared the food to limit if you have chronic inflammation. Related: The One Diet That Will Actually Lower Your Heart Attack Risk, According to Cardiologists
What does the medical peer reviewed literature say may be at the root of the following diseases: Metabolic Syndrome/Insulin Resistance/Diabetes Cardiovascular Disease Cancer Obesity Depression Autoimmune Disease Neurodegenerative disease (Alzheimer's and Parkinson's disease) Osteoporosis Immunosenescence (the progressive decline in immune function with increasing age) The Answer is: INFLAMMATION
18 or 80 most anyone can do these. Remember create a habit first. Perform these exercises just twice a week.
