The osteoarthritis it is the most common form of arthritis. It is a chronic, degenerative and progressive disease, with an estimated incidence of 800,000 patients per year. More than 10% of patients with osteoarthritis of the knee seek non-invasive treatment to relieve pain through injections of corticosteroids or hyaluronic acid.
Investigators for both studies chose cohorts from the Osteoarthritis Initiative, a multicenter longitudinal observational study of nearly 5,000 participants with knee osteoarthritis that is currently in its 14th year of follow-up.
In the first study, researchers at the University of California, San Francisco (USA) included 210 Osteoarthritis Initiative participants, 70 of whom received intra-articular injections, and a control group of 140 who received no injections over a two-year period. Of the 70 patients who received injections, 44 were injected with corticosteroids and 26 with hyaluronic acid. Treatment and control groups were matched for age, sex, body mass index, pain and physical activity scores, and disease severity.
An MRI was performed on all patients at the time of injection and two years before and after. MRIs were assessed using the Whole Organ MRI Score (WORMS), a classification system for knee osteoarthritis that focuses on meniscus, bone marrow, cartilage, joint effusion, and joint lesions. ligaments. The investigators identified osteoarthritis progression by comparing the imaging scores from the baseline scans and the two-year follow-up.
“This is the first direct comparison of corticosteroid and hyaluronic acid injections using semiquantitative whole-organ MRI evaluation of the knee,” said Upasana Upadhyay Bharadwaj, MD, a researcher in the Department of Radiology at the University of California at San Francisco.
Statistical analysis showed that the knee corticosteroid injections they were significantly associated with the general progression of osteoarthritis in the knee, specifically in the lateral meniscus, lateral cartilage and medial cartilage.
Hyaluronic acid knee injections were not significantly associated with the progression of knee osteoarthritis. Compared with the control group, the group that received hyaluronic injections showed a less progression of osteoarthritisspecifically in spinal cord injuries.
“Although both corticosteroid and hyaluronic acid injections have been reported to help relieve symptomatic pain in knee osteoarthritis, our results conclusively demonstrate that corticosteroids are associated with significant progression of knee osteoarthritis to two years after injection and should be administered with caution,” explains Upadhyay Bharadwaj. “Hyaluronic acid, on the other hand, can slow the progression of knee osteoarthritis and alleviate the long-term effects, while offering symptomatic relief.”
In the second study, researchers at the Rosalind Franklin University of Medicine and Science, Chicago School of Medicine (USA) conducted a case-control study comparing the radiographic progression of osteoarthritis in patients who received injections of corticosteroids and hyaluronic acid.
Hyaluronic acid injections in the knee were not significantly associated with the progression of osteoarthritis in the knee.
“Although these injections provide some patients with short-term pain relief, the effects of injections on disease progression are unknown,” says researcher and medical student Azad Darbandi.
Darbandi’s team selected a cohort of 150 patients with similar baseline characteristics from the Osteoarthritis Initiative database, which included 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who did not receive injections over a 36-month period. Groups were matched for sex, body mass index, and radiographic results.
Patients underwent knee x-rays at baseline and two years later. The researchers analyzed the radiographic images, including joint space narrowing, bone spur formation, and thickening of the bone around the knee cartilage.
Compared with patients receiving an acid injection hyaluronic or receiving no treatment, those injected with corticosteroids had significantly greater OA progression, including medial joint space narrowing, a hallmark of the disease.