Conclusion
There is no clear evidence that corticosteroids injected into the osteoarthritic knee, hip, or other joints have long term benefit. Definite evidence exists, however, primarily from animal studies, that corticosteroids are harmful to the articular cartilage. Intraarticular corticosteroid injections result in severe deleterious effects, both mechanical and physiological, on the joint and articular cartilage. Most of these changes are dose-related. The catabolic effects of intraarticular corticosteroids include a massive decrease in the synthesis of all major articular cartilage matrix components. The loss of glycosaminoglycans, proteoglycans, proteins and matrix collagen leads to the ultimate breakdown of the articular cartilage. The net result of corticosteroid joint injections is an acceleration of the osteoarthritic process which is manifested in the dramatic rise of cases of osteoarthritis of the knee and hip and subsequent joint replacements. Forty years ago, in an Editorial for the British volume of the Journal of Bone and Joint Surgery, Sweetnam stated, “We now have evidence, both clinical and experimental, that apart from the well recognized hazard of infection, intraarticular injections of corticosteroids, certainly, if repeated, may be harmful, yet the practice has continued. We believe that it should now cease.”131, 132 This sentiment is reiterated by the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine who state, “Although an extremely useful technique, the intermittent use of intraarticular cortisone should be deployed with caution. The potential risks of provoking hyaline cartilage degeneration, the hazards as they relate to joint infections, and the limitations of cortisone, should be fully discussed and disclosed with the patient.”133, 134
In summary, intraarticular corticosteroid injections degenerate articular cartilage in osteoarthritis. Studies have shown no long term benefit in joint osteoarthritis and substantial scientific evidence has been offered to the contrary, that the long-term sequelae of injections of corticosteroids into degenerated joints accelerates the arthritic process. Despite its widespread use, substantial scientific evidence exists to dissuade both clinicians and patients from using intraarticular corticosteroids in the treatment of osteoarthritis. The continued use of intraarticular corticosteroid injections in the treatment of osteoarthritic joints is deplorable.
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