Glucocorticoid Injections and Risk of Worsening OA in Knees

Investigators have found that patients with osteoarthritis (OA) of the knee who received intra-articular (IA) glucocorticoid injections were not at increased risk of needing total knee replacement or experiencing progression of OA during a 5-year follow-up period.

In a study published in Arthritis & Rheumatology, the researchers stated they undertook the study to assess the risk of OA progression in a real-life setting among these patients. They also examined outcomes among patients who received IA hyaluronan (IAHA) injections.

“We used marginal structural modeling with inverse probability of treatment weighting to determine the causal association between IA glucocorticoid injections and the 5-year risk of disease progression in patients with symptomatic knee OA from the Knee and Hip Osteoarthritis Long-term Assessment cohort,” the authors wrote. They defined OA progression “as an incident total knee replacement (TKR) and/or radiographic worsening (Kellgren/Lawrence [K/L] grade or joint space narrowing [JSN])” during the 5-year period.

“Among the 564 patients with knee OA included in the study sample, 51 (9.0%) and 99 (17.5%) received IA glucocorticoid or IAHA injections, respectively, and 414 (63.1%) did not receive any injection during follow-up,” they explained. Patients treated with IA glucocorticoid injections had a similar risk of incident TKR (hazard ratio [HR] 0.92 [95% confidence interval (95% CI) 0.20, 4.14]; P = 0.91) or K/L grade worsening (HR 1.33 [95% CI 0.64, 2.79]; P = 0.44) as those who did not receive any injections. The study also showed that IAHA injections had no effect on the risk of TKR (HR 0.81 [95% CI 0.14, 4.63]; P = 0.81), K/L grade worsening (HR 1.36 [95% CI 0.85, 2.17]; P = 0.20), or JSN.  The results were similar when TKR and radiographic outcomes were combined.

However, the authors stated, “These findings should be interpreted cautiously and replicated in other cohorts.”

—Rebecca Mashaw

Reference:

Latourte A, Rat AC, Omorou A, et al. Do glucocorticoid injections increase the risk of knee osteoarthritis progression over 5 years? Arthritis Rheumatol. 2022; 74(8): 1343-1351