New evidence that hip and knee steroid injections more dangerous than thought

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Boston University School of Medicine (BUSM) researchers have found accelerated arthritis and joint destruction can be the unintended result of intra-articular corticosteroid injections.

Osteoarthritis of the hip and knee is among the most common joint disorders. A frequently (thousands per day worldwide) performed treatment for osteoarthritis and other joint related pain syndromes are intra-articular corticosteroid injections, yet there is conflicting evidence on their potential benefit.

The researchers conducted a search on patients they had injected during (2018) in the hips and knees and found out that 8% had complications, with 10% in the hips and 4% in the knees.

“We are now seeing these injections can be very harmful to the joints with serious complications such as osteonecrosis, subchondral insufficiency fracture and rapid progressive osteoarthritis,” said corresponding author Dr Ali Guermazi, chief of radiology at VA Boston Healthcare System and professor of radiology at BUSM. “Intra-articular corticosteroid injection should be seriously discussed for pros and cons. Critical considerations about the complications should be part of the patient consent which is currently not the case right now,” he added.

Given that intra-articular corticosteroid injections are increasingly performed for treatment of pain in hip and knee osteoarthritis, researchers suggest that the radiologic community should actively engage in high-quality research about this topic, to better understand potential at-risk conditions prior to intervention and to better understand potential adverse joint events following these procedures to avoid possible complications.

Abstract
Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications.

Authors
Andrew J Kompel, Frank W Roemer, Akira M Murakami, Luis E Diaz, Michel D Crema, Ali Guermazi

Boston University School of Medicine material

Radiology abstract

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