Are Corticosteroids Harmful to Joints? – George C. Chang Chien, DO

Corticosteroid injections have been a mainstay in treating painful musculoskeletal conditions for decades. Recently, increasing caution has been raised regarding the long-term safety and deleterious effects of corticosteroids on the human body. A 2017 article, published in JAMA “Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis, A Randomized Clinical Trial” sought to quantify the effects of corticosteroids on cartilage volume.

140 patients with symptomatic knee osteoarthritis were randomly selected to be treated with intra-articular triamcinolone compared with intra-articular saline. Patients were re-evaluated every three months for two years to monitor their knee pain, and progression of cartilage loss. Patients underwent annual knee magnetic resonance imaging for quantitative evaluation of cartilage volume.

Intra-articular triamcinolone resulted in significantly greater cartilage volume loss than did saline for a mean change in index compartment cartilage thickness of −0.21 mm vs −0.10 mm.

This is a well-performed study published in a well-respected journal. These findings provide measurable volumetric evidence to support the deleterious effects of corticosteroids on cartilage health found in basic science literature.  Critics of the basic science literature demonstrating catabolic effects of corticosteroids on cartilage and tendon tissue, cite the in vitro nature of the lab studies. This important study supports what many clinicians have recognized all along, that repeated intra-articular corticosteroid injections are harmful to soft tissues.

As Regenerative Medicine experts, we recommend minimizing corticosteroid injections when possible. Regenerative Medicine procedures such as Platelet Rich Plasma (PRP) and bone marrow-derived mesenchymal stem cells have demonstrated anabolic effects on tenocytes, and chondrocytes.

To learn more about how to incorporate Regenerative Medicine into your practice, join us for an interactive course through Apex Biologix.

 

https://jamanetwork.com/journals/jama/fullarticle/2626573