Monday, February 18, 2019

Joint steroid injection? Think twice…

There are ongoing concerns that steroid injections for painful knee osteoarthritis [1,2] may have the negative effect of accelerating joint breakdown while having no benefit – including for pain control – compared to placebo injections.  This is in addition to data showing that even short-term steroids (as well as other anti-inflammatory medications) have significant potential for harm to overall health.

My recommendation:
This is an area of legitimate debate; however, given both the uncertainty regarding the benefit and the potential harm, I strongly recommend that patients exhaust all other options before having steroid injections.  The alternative is a plan that includes meticulous attention to diet, weight, blood sugar management, appropriate exercise, and topical or oral pain medications.  There are some nutritional supplements that may help, and targeted physical therapy can make an enormous difference.  Occasionally I use lidocaine injections without steroids and see excellent results.

Keep the most important goals in mind: less pain and improved function in the short term, and avoiding further joint breakdown or joint replacement in the long run.  Make sure you have all options in view.  (See my 5/1/2017 blog post on corticosteroids for more information about short-term oral steroids.)

Miles Hassell MD

[2] McClindon, T. et al. JAMA 2017;317:1967-75