Can steroid use cause knee pain or joint pain?

From the Guidelines

Steroid use can cause knee pain and joint pain, particularly when used long-term or at high doses, and patients experiencing such pain should consult their healthcare provider to evaluate the cause and potentially adjust their treatment plan. Both anabolic steroids (used for muscle building) and corticosteroids (used for treating inflammation) can affect joints in different ways. Anabolic steroids can lead to rapid muscle growth that puts excessive stress on tendons and joints, potentially causing pain, tendinopathy, and even tendon ruptures. Corticosteroids, while initially reducing inflammation and pain, can cause joint deterioration with prolonged use through a condition called steroid-induced osteonecrosis, where bone tissue dies due to decreased blood supply, as noted in studies such as 1. They may also weaken surrounding tendons and ligaments, making joints less stable. Additionally, corticosteroids can cause osteoporosis (bone thinning) with long-term use, further compromising joint integrity. Some patients experience a phenomenon called "steroid flare," which is temporary increased pain after corticosteroid injections into joints.

Key Points to Consider

• The use of steroids, especially long-term, can have detrimental effects on joint health, including osteonecrosis and osteoporosis, as discussed in 1 and 1.
• Anabolic steroids can cause rapid muscle growth, leading to excessive stress on joints and potential for injury.
• Corticosteroids, while providing initial relief, can lead to joint deterioration and instability with prolonged use.
• Patients should be aware of the potential risks and monitor their joint health closely when using steroids, with guidance from healthcare providers, as recommended in 1 and 1.

Recommendations for Management

• For patients with knee pain or joint pain associated with steroid use, consultation with a healthcare provider is crucial to assess the cause of pain and adjust the treatment plan accordingly, as suggested in 1.
• Alternative treatments, such as physical therapy, weight management, and non-steroidal anti-inflammatory drugs (NSAIDs), may be considered to manage pain and reduce reliance on steroids, as recommended in 1.
• Regular monitoring of bone density and joint health is essential for patients on long-term steroid therapy, to mitigate the risk of osteoporosis and osteonecrosis, as implied in 1 and 1.

From the Research

Steroid Use and Knee Pain

• Steroid use can have both positive and negative effects on knee pain and joint pain, depending on the context and duration of use 2, 3.
• Intra-articular corticosteroid injections are commonly used to reduce pain and inflammation in osteoarthritis (OA) patients, and studies have shown that they can be effective in providing symptom relief 3, 4.
• However, long-term use of oral NSAIDs and intra-articular corticosteroids can lead to negative side effects, including cartilage degradation and joint damage 2.

Effects of Steroids on Joint Health

• Some studies have found that intra-articular steroid injections can reduce inflammation and cartilage damage in OA patients, and may even be chondroprotective 5.
• However, other studies have found that steroid injections may not provide additional benefits in reducing pain sensitivity in OA patients, and may even have negative effects on joint health in the long term 4, 6.
• The use of steroids in OA treatment should be carefully considered, taking into account the potential benefits and risks, as well as the individual patient's needs and medical history 2, 3.

Key Findings

• A randomized, double-blind, placebo-controlled trial found that long-term intra-articular steroid injections were safe and effective in reducing knee pain and improving symptoms in OA patients 3.
• Another study found that intra-articular steroid injection combined with exercise did not reduce synovial hypertrophy, synovial Doppler activity, or Baker's cyst presence more than a placebo saline injection in OA patients 4.
• A study using a new model of post-traumatic osteoarthritis found that repeated intra-articular injections of high-dose dexamethasone protected the cartilage from damage and decreased joint inflammation 5.