“Intra-articular corticosteroid injections were specifically linked to an increased progression of structural knee OA, as assessed using the WORMS system. This progression was notable not only in the overall WORMS but also specifically in cartilage degradation, suggesting that corticosteroids may accelerate cartilage loss, which is a key indicator of OA advancement,” wrote lead study author Upasana U. Bharadwaj, M.D., who is affiliated with the Department of Radiology and Biomedical Imaging at UCSF Medical Center in San Francisco, and colleagues.
Three Key Takeaways
1. Corticosteroid injections may accelerate OA progression.
Intra-articular corticosteroid injections were linked to increased structural progression of knee osteoarthritis (OA), especially in terms of cartilage degradation, as measured by MRI-based WORMS scores.
2. Hyaluronic acid (HA) injections may offer structural protection. Patients who received HA injections showed reduced progression in WORMS scores and cartilage degradation, suggesting a potential protective or stabilizing effect on knee joint structure.
3. MRI evidence supports preferential use of HA for long-term management. While corticosteroids may offer short-term pain relief, MRI findings indicate that HA injections may be more beneficial for long-term joint preservation in knee OA patients.
Based on the post-injection MRI findings at two years, the study authors suggested that HA injections may have a stabilizing impact on the structural integrity of the knee.
“The progression of OA-related changes, particularly in cartilage, was lower during the post-injection period than during the injection-concurrent period. This suggests that HA may have a moderating effect on structural damage, potentially stabilizing cartilage health after the initial injection phase,” posited Bharadwaj and colleagues.
(Editor’s note: For related content, “New Interventional Radiology Research Shows Merits of Genicular Artery Embolization for Knee OA,” “Could AI-Powered Abbreviated MRI Reinvent Detection for Structural Abnormalities of the Knee?” and “Study Examines Impact of Deep Learning on Fast MRI Protocols for Knee Pain.”)
In regard to study limitations, the researchers noted the observational study design and that a variety of factors, ranging from type of injection to changes in knee structure and pain, can influence the use of intra-articular knee injections. Emphasizing that study participants were only asked about knee injections they had in the preceding six months, the study authors conceded a lack of clarity on whether participants had only one knee injection or whether there were any injections in control knees.
