From the Guidelines
Steroids, specifically intra-articular corticosteroid injections, are recommended for managing osteoarthritis symptoms, particularly during flare-ups, as they provide temporary relief lasting 3-4 weeks up to 3 months, as supported by the most recent and highest quality study 1.
Key Points to Consider
- Intra-articular corticosteroid injections, such as methylprednisolone or triamcinolone acetonide, can be effective for short-term pain relief in osteoarthritis patients, especially during flare-ups 1.
- These injections should be limited to 3-4 times per year in the same joint to minimize the risk of cartilage damage, as suggested by the 2022 AAOS clinical practice guideline summary 1.
- Oral steroids, like prednisone, may be prescribed for severe flares but are not recommended for long-term use due to significant side effects, including bone loss, weight gain, and increased blood sugar 1.
- The use of steroids should be part of a comprehensive treatment plan that includes physical therapy, weight management, and other pain management strategies, as emphasized by the 2019 American College of Rheumatology guideline 1.
Important Considerations
- Patients with diabetes should closely monitor their blood glucose levels when using steroids, as they can cause significant elevations in blood sugar 1.
- The choice of steroid preparation and dosage may impact efficacy and safety, although there is currently insufficient evidence to make specific recommendations, as noted in the 2019 American College of Rheumatology guideline 1.
- The potential for cartilage loss with repeated steroid injections is a concern, but the clinical significance of this finding is uncertain, as discussed in the 2020 study 1.
From the Research
Steroids for Osteoarthritis
- Osteoarthritis (OA) is a common joint disease that affects millions of people worldwide, causing joint dysfunction, pain, stiffness, and functional limitation 2.
- The management of OA typically involves exercises, weight loss, education, and the use of topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs), as well as intra-articular steroid injections for short-term pain relief 2.
Intra-Articular Steroid Injections
- Intra-articular steroid injections are a common treatment for OA, providing short-term pain relief and reducing inflammation 2, 3.
- However, the efficacy of steroid injections compared to other treatments, such as hyaluronic acid and platelet-rich plasma (PRP), is still debated 4, 5, 6.
- A network meta-analysis of randomized controlled trials found that PRP injections resulted in the greatest improvement in pain and functional outcomes in patients with knee OA at up to 1 year of follow-up 3.
- Another study found that PRP injections were superior to corticosteroid injections for symptomatic management of knee OA, with improved pain management, less joint stiffness, and better participation in exercise/sporting activity at 12 months follow-up 5.
Comparison of Treatments
- A Bayesian network meta-analysis compared the efficacy of intra-articular infiltrations of placebo, steroids, hyaluronic acid, and PRP for knee OA, and found that PRP showed the best overall outcome at 3,6, and 12 months follow-up 6.
- The same study found that among corticosteroids, hyaluronic acid, and placebo, no discrepancies were detected in terms of efficacy 6.
- Another study found that hyaluronic acid may be a useful additional therapy for symptomatic knee OA, with a long duration of action 4.