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

Abstract

Objective: A recent randomized clinical trial reported that repeated intra-articular corticosteroids (IACs) were associated with a greater cartilage loss. This study aimed to examine the relation of IACs to knee radiographic osteoarthritis (ROA) progression in a real-world setting. Design: A cohort that initiated IACs and a comparison cohort without IACs from participants with mild to moderate knee ROA in the Osteoarthritis Initiative (OAI) were assembled (from 0-month to 48-month). Two measures of knee ROA progression were assessed during the follow-up period: (1) an increase in Kellgren and Lawrence (KL) grade by 1 grade or having a knee replacement (i.e., KL grade worsening); and (2) a decrease in joint space width (JSW) by 0.7 mm or having a knee replacement (i.e., JSW worsening). The associations of IACs initiation using a propensity-score matched cohort study and continuous IACs using marginal structural models with the risk of knee ROA progression were examined. Results: Among 684 propensity-score matched participants at baseline (148 IACs initiators, 536 comparators), 65 knees (21.7/100 person-years) in the IACs initiation cohort and 90 knees (7.1/100 personyears) in the comparison cohort experienced KL worsening. The hazard ratios (HRs) of KL worsening from IACs initiation and continuous IACs were 3.02 (95% confidence interval [CI], 2.19e4.16) and 4.67 (95% CI, 2.92e7.47), respectively. The corresponding HRs of JSW worsening were 2.93 (95% CI, 2.13e4.02) and 3.26 (95% CI, 1.78e5.96), respectively. All HRs for continuous use of IACs were further away from the null. Conclusions: IACs, especially continuous IACs, may be associated with an increased risk of knee ROA progression.

Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis

“…Although players recalled their history of knee injections during their professional careers (predominantly in their 20s and 30s) and measured KOA in later life (mean age of cohort was 59 years) after they retired, we certainly cannot infer causality between KIA and KOA using this study design. However, our results are in line with the literature from both randomised controlled trials [9] and observational studies [23] in the general population. A long-term prospective follow-up study from playing professional football through to retirement and beyond is required to establish potential causal pathways.…”

Osteoarthritis year in review 2019: epidemiology and therapy

“…Recent it was shown in a randomized double-blind clinical trial that repeated intraarticular corticosteroids in knee OA were associated with greater cartilage loss on MR images after 2 years than intraarticular saline injections 20 . To further increase insight into the effects of intraarticular corticosteroid injections in knee OA an observational study was set up by Zeng et al using the 0e48 months radiographic data of the OA Initiative 21 . Knees with radiographic OA of 148 participants that had initiated a corticosteroid injection were compared to osteoarthritic knees from 536 propensity-matched participants that did not receive such an injection.…”

Is there a place for intra-articular corticosteroid injections in the treatment of knee osteoarthritis?

“…While corticosteroid injections have been found to be safe in the short term, long term harms have not been well assessed. Recent cohort studies suggest possible risk of progression of osteoarthritis and worsening symptoms in patients prescribed intra-articular corticosteroid 89…”