HEALTHY LIVING


New Studies Cast Doubt on Steroid Shots for Knee Pain


Researchers say they’re not eff ective in treating arthritis. ::


BY CHRIS ILIADES, M.D. T


wo new studies have suggested that steroid injections to relieve pain in the knee were associated


with more progression of osteoarthritis over time than no injections. The most common type of arthritis, osteoarthritis of the knee, is usually caused by the wear and tear of time and progressive loss of cartilage. Knee osteoarthritis causes


symptoms of pain and stiff ness in about 40% of men and women by age 70. New research, presented to


the Radiological Society of North America, suggests that steroid knee injections should be done less, and hyaluronic acid injections may be safer and more eff ective. But Scott E. Mabry, M.D., an


orthopedic surgeon and assistant professor of orthopedics at the University of Alabama at Birmingham, reviewed the studies and thinks those suggestions may be premature. “I use both types of injections,”


he explains. “Steroids are used when


someone has more severe pain and infl ammation because they are more reliable than hyaluronic acid. “It may be that people in the studies


who got steroid injections had more progression because they had worse


86 NEWSMAX MAXLIFE | JULY 2023


arthritis, not because of any damage done by the steroids.”


TREATMENT OPTIONS According to the American Academy of Orthopedic Surgeons (AAOS) guidelines, the fi rst treatments for knee osteoarthritis are physical therapy and home exercise, oral nonsteroidal anti- infl ammatory drugs (NSAIDs), and weight loss, if needed. When initial treatments don’t help,


steroid or hyaluronic acid injection may be recommended to relieve pain and disability, Mabry explains. He says these injections are not meant to slow disease progression. As osteoarthritis progresses, joint


fl uid and the cartilage that protects the ends of the bones inside the knee joint are reduced, causing the joint space to narrow and bone to rub on bone. “Steroids injected into the joint,


usually combined with an anesthetic, reduce pain, swelling, and stiff ness for most people. “Hyaluronic acid helps some people,


but not others. It may protect the remaining cartilage, but there is not much evidence that it prevents disease progression,” Mabry says. Current AAOS guidelines


recommend steroid injections but say evidence for hyaluronic acid injection is not as highly supported by research.


“Steroid injections can be given


about every three to four months, as needed,” Mabry says. “Hyaluronic acid injections about every four to six months. “The recent studies suggesting


hyaluronic acid as more protective and safer than steroids are not based on large numbers of patients, so until we have more research, there is no reason to change the guidelines.”


WHAT TO DO Researchers from both trials caution that more research is needed. Until more research is done, talk


to your doctor about what treatments, including injections, are the best options for relieving your knee pain. “For people who continue to have


progression of osteoarthritis with pain and disability and have irreversible changes on imaging studies of the knee, despite initial therapies and injections, it is time to talk to your doctor about joint replacement therapy,” Mabry advises. Total or partial knee replacement


is the best treatment for people who have trouble walking, getting up out of a chair, or going up stairs due to osteoarthritis. For most people, surgery provides


relief and improved mobility for more than 15 years.


GROUND PICTURE/SHUTTERSTOCK


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