Intra-articular Corticosteroids and Knee Osteoarthritis

Abstract

Osteoarthritis, the most common form of arthritis, affects approximately 27 million individuals in the United States. 1 With the aging of the population and rising rates of obesity, the prevalence of osteoarthritis is increasing. 2 Roughly 25% of adults aged 55 years or older have knee pain on most days, and most of these people have osteoarthritis. 3 According to studies of the global burden of diseases, 4 the effect of osteoarthritis on adverse health outcomes is increasing rapidly, especially in developed countries where people have extended life spans.Osteoarthritis develops after a joint is damaged repeatedly by a combination of mechanical stresses and a suboptimal repair response to the damage. Aging diminishes repair capacity and low-grade inflammation, a common feature of the osteoarthritic joint, probably also impairs healing. Many factors contribute to the inflammatory process in osteoarthritis such as inflammatory cytokines synthesized and released into the joint environment by multiple tissues, including cartilage and synovium. Synovial inflammation, which exists to varying degrees among persons with osteoarthritis, is a major source of cytokines and other inflammatory mediators. In imaging studies, synovial thickening is indicative of synovial inflammation. The amount of synovial thickening correlates with knee pain severity in persons with osteoarthritis, 5 and synovial thickening is associated with subsequent radiographic osteoarthritis and cartilage loss. 6,7 Given the association of inflammation with pain and structural damage in osteoarthritis, treatments targeting inflammatory processes have potential promise. Corticosteroids are thought to counteract inflammatory processes within the osteoarthritic joint. In support of this concept, a recent study 8 documented that patients receiving an intra-articular corticosteroid injection experienced a reduction in synovial volume and the amount of reduction was correlated directly with the reduction in knee pain. Intra-articular corticosteroids are a mainstay of treatment for osteoarthritis. In an animal model of osteoarthritis, 9 corticosteroids reduced synovial inflammation, angiogenesis, and pain.Clinical trials and meta-analyses of studies in humans have reported that intra-articular corticosteroids are more effective than placebo in relieving pain from knee osteoarthritis, although this treatment effect lasts only 1 to 4 weeks following an injection, after which the treatment and placebo groups experience a similar course. In 2 meta-analyses, Arroll and Goodyear-Smith 10 and Bellamy et al 11 suggested that in the first 1 to 2 weeks after a corticosteroid injection, the treatment effect was large with 18. Zou K, Wong J, Abdullah N, et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis.

Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative

“…Another trial (n ¼ 140), that was adequately powered and utilized more sensitive imaging technique (i.e., magnetic resonance imaging [MRI]), demonstrated a detrimental effect of IACs on cartilage volume, although the amount of cartilage loss was small and may not be clinically meaningful 17 . However, in both trials, repeated IACs were administered to participants during the study period regardless of the flare of pain or inflammatory signs, which are the usual indications for such injections in clinical practice 39,40 . IACs have been used for pain relief among patients with knee OA for decades.…”

Efficacy and Safety of Hylan G-F 20 Versus Intra-Articular Corticosteroids in People with Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis

“…Comparative estimates for the continuous outcomes measured on the same scale were represented as mean difference (MD) with associated 95% confidence intervals (CI). We used these models to assess statistical heterogeneity by inspecting the forest plots, and the calculated I 2 using the R software package “metafor.” 30 Estimates based on direct and indirect evidence were compared to assess potential inconsistency.…”

“…Osteoarthritis (OA) is a leading cause of disability and the most common form of arthritis affecting around 250 million people worldwide, 1 and more than 27 million people in the United States. 2 Multiple factors play a role in development of OA, with elderly females, people with obesity, and African Americans being at greater risk of developing OA. 3 Treatment for people with symptomatic OA of the knee starts with participation in self-management programs, neuromuscular education, and engagement in physical activity such as strengthening or low-impact aerobic exercises.…”

A cyclic brush zwitterionic polymer based pH-responsive nanocarrier-mediated dual drug delivery system with lubrication maintenance for osteoarthritis treatment

“…So far, the most widely used joint injection materials in the clinical stage include hyaluronic acid (HA), 19 corticosteroids (GC), 20,21 platelet-rich plasma (PRP) 22 and stem cell therapy. 23 Although it has been reported that diclofenac sodium (DS), 1,24 curcumin (Cur), 25,26 loxoprofen (LXP), 27 etc.…”