General Guidelines for Intrarticular Costicosteroid Usage in Osteoarthritis of a Joint
The guidelines published by the American College of Rheumatology note, “It is generally recommended, although not well supported by published data, that injection of corticosteroids in a given joint not be performed more than three to four times in a given year because of concern about the possible development of progressive cartilage damage through repeated injection in the weight-bearing joints.”128 The guidelines given by the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine state, “Although an extremely useful technique, the intermittent use of intrarticular 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 to the patient.”129
These guidelines are a far cry from what used to be the standard of care. What most patients do not realize is that rheumatologists in the 1950s and 60s used to give ten or more steroid injections per joint per year. Some patients receiving more than 150 steroid injections into their joints.130
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