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Intraarticuler Corticosteroid Usage is Common

Since its introduction in the early 1950s, the use of corticosteroid compounds by intraarticular injections has become a common practice in orthopedics and sports medicine. (See Figure 12.) Prompt and effective reduction of local inflammation occurs after intraarticular injection of corticosteroids. Most of the substances released by the damaged cells to cause inflammation are greatly decreased in quantity. Corticosteroids also inhibit fibroblasts, collagen deposits, and reduce capillary formation, thus limiting the formation of scar tissue. Generally the relief of pain and inflammation is obtained within a few hours after the injection and can last a few days or a few weeks. Because of their pain-relieving effects, corticosteroids are commonly used in both human and veterinary medical practices.

Intraarticular corticosteroids are recommended in several guidelines for the treatment of patients with knee osteoarthritis.^103-105 Rheumatologists in particular when surveyed state that over 95% of them use them at least sometimes and 53% frequently in the treatment of osteoarthritis of the knee and hip.^{106, 107}

While most controlled studies have shown that intraarticular corticosteroid injections are superior to placebo injections for osteoarthritis of the knee, the benefit of such injections is short-term generally lasting from one to three weeks.108-115 (See Figure 13.) No improvement in long-term pain or function has been shown by intraarticular corticosteroid injections into the knee. Even systematic reviews summarizing the evidence of intrarticular corticosteroid injections in patients with osteoarthritis of the knee have confirmed that inadequate data exists related to the beneficial use of corticosteroid injections for knee osteoarthritis besides one to three weeks of pain relief.^116-120 In randomized controlled studies of intraarticular corticosteroid injections of other joints including the hip and carpometacarpal joint of the thumb, again short-term results of a few weeks of pain relief was seen, but no long term benefits could be documented.^121-125 One reviewer called the response to intraarticular corticosteroids “brief and transient,” noting that the number of potential adverse effects of intraarticular corticosteroids stresses the importance of their judicious use.¹²⁶ Another review summarized it nicely, “ Local injections of corticosteroids are commonly used in orthopaedic practice on the assumption that they will diminish the pain of inflammation and accelerate healing. Less often considered is the possibility that their use may delay the normal repair response. Unfortunately, there is a paucity of well-controlled studies that provide definitive recommendations for nonrheumatologic use of corticosteroids. Also troubling are the significant potential complications that can occur with their use. The authors believe that use of corticosteroids should be limited to the few conditions that have been proved to be positively influenced by them.”¹²⁷ In this author’s opinion osteoarthritis is not one of them.