For years we have known the use of steroid (cortisone) injections inside a joint (intra-articular) is bad for the joint. Now we have the proof.
A recent clinical study published in the Journal of The American Medical Association answered the question: Is the use of steroid medications inside a joint good or bad for the joint?
The objective of the study was to determine the effects of intra-articular injection of a synthetic cortisone preparation every 3 month on progression of cartilage loss and knee pain. Read on to learn about what was learned…
What Happened In the Study?
The study had 140 patients divided into two groups of 70 each. In one group, a steroid medication (40 mg of triamcinolone acetonide) was injected into a knee every three months, and in the other group, saline (biologic salt water which has no effect on the body) was injected every three months. An MRI was done on each patient at the end of two years to assess the results.
The results of the study showed the group that had steroid medication injected had significantly greater cartilage volume loss and no significant difference in knee pain, when compared to the group with intra-articular saline injections. These findings do not support the use of steroid injections for knee pain.
What is Synovitis?
Synovitis in inflammation of the synovial membrane which lines all joints. This inflammation can be destructive to both cartilage and bone. Synovitis is common and is associated with progression of structural characteristics of knee osteoarthritis. Intra-articular corticosteroids could reduce cartilage damage associated with synovitis, but has adverse effects on cartilage and particularly bone.
The use of intra-articular triamcinolone compared with intra-articular saline resulted in greater cartilage volume loss without significant difference on knee pain severity between treatment groups over the two-year study period.
What is the Alternative to Steroid Injections?
The alternative to the use of steroid (cortisone) injections is to use something else that is effective in relief of joint pain and at the same time to stimulate the joint to regenerate or heal. At PM&R Associates, we have several alternative “medications” that we can inject. The one we usually use first is dextrose diluted to the correct concentration. This is the weakest regenerative medication we can use, but it usually works if the arthritis is not too severe. Typically, repeat injections are required, but we do not charge extra for dextrose. Stronger is Platelet Rich Plasma (PRP). Platelets are in the patient’s blood. Blood is obtained, the platelets are separated and then injected into the joint. PRP injections typically work better and last much longer than dextrose and there is an out of pocket charge.
If necessary, commercially available growth factors can be added to the PRP. The strongest and longest lasting treatment is stem cells. These can be obtained from adipose tissue (fat) or bone marrow. Commercially available growth factors can be added to the stem cells to help ensure a good result.
These findings and recommendations would apply to any joint.
More information is available at our website https://www.stemcellsindiana.com. Visit the website and set-up a consultation, here at PM&R Associates, we will be happy to discuss your condition and the treatments you have available to you.
- The article quoted above is: Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain
in Patients With Knee Osteoarthritis A Randomized Clinical Trial
JAMA May 16, 2017 Volume 317, Number 19, 1967-1975.
- To read the study, go to gov, Identifier:NCT01230424