The research by no means suggests that rheumatologists should altogether avoid steroid injections to treat knee pain of patients with OA, he says. In some cases, the injections can help break a cycle and deal with an acute escalation of pain.
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In other words, rheumatologists considering treatment options for osteoarthritic knee pain should not interpret the study results as a reason to ban steroids, notes Dr. McAlindon. “I wouldn’t want [these results] to discourage people from having the occasional steroid injections, because those are useful for short-term pain,” he says.
However, the findings do indicate that repeated injections over two years show no real long-term benefit in relation to a patient’s pain or the management of OA and structural progression. In addition, although the greater cartilage loss observed in the treatment group was not considered clinically significant, it could make a difference in a patient’s quality of life over a longer stretch of time, Dr. McAlindon says.
“Losing cartilage faster over the years makes the need for knee joint replacement more likely,” he says.
Discussion of study limitations in the article points out that any transient benefit on pain ending within the three-month period between each injection could have been missed, because pain was not measured within the four-week period after each injection.
Catherine Kolonko is a medical writer based in Oregon.
- McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis. A randomized clinical trial. JAMA. 2017 May 16;317(19):1967–1975.