From the Guidelines
Corticosteroids are not contraindicated for bone-on-bone arthritis, but they should be used cautiously and as a short-term solution. For patients with severe osteoarthritis where the cartilage has worn away completely (bone-on-bone), corticosteroid injections such as triamcinolone (40mg) or methylprednisolone (40-80mg) can provide temporary pain relief, typically lasting 1-3 months, as supported by the 2020 American College of Rheumatology guideline 1. However, these injections should be limited to 3-4 times per year with at least 3 months between injections to minimize potential side effects. The 2021 US Department of Veterans Affairs/US Department of Defense clinical practice guideline also recommends considering intra-articular corticosteroid injections for knee and hip OA, but advises avoiding them for 3 months preceding joint replacement surgery 1. Recent research suggests that repeated corticosteroid injections may potentially accelerate cartilage loss over time, though this remains somewhat controversial. For bone-on-bone arthritis, comprehensive management should include other approaches such as:
- Physical therapy
- Weight management
- Oral pain medications (NSAIDs, acetaminophen)
- Eventually consideration of joint replacement surgery if conservative measures fail. Corticosteroids should be viewed as a bridging therapy to help manage pain while pursuing these other treatment options, not as a long-term solution for bone-on-bone arthritis.
From the Research
Corticosteroid Use in Bone-on-Bone Arthritis
- The use of corticosteroids in bone-on-bone arthritis is a topic of debate, with some studies suggesting that they can provide short-term pain relief, but may also have negative effects on the joint 2, 3.
- A study published in The Bone & Joint Journal found that intra-articular corticosteroid injections increased the risk of requiring knee arthroplasty, with a hazard ratio of 1.57 (95% confidence interval 1.37 to 1.81; p < 0.001) 4.
- Another study published in Joint Diseases and Related Surgery recommended avoiding repeated injections and keeping the interval between hip injection and hip arthroplasty to more than three months 2.
- The National Institute for Health and Care Excellence (NICE) UK guidelines recommend NSAIDs as the first-line drugs for OA, but do not provide specific guidance on the use of corticosteroids in bone-on-bone arthritis 5.
Potential Risks and Contraindications
- Corticosteroids can cause bone loss and osteoporosis, particularly with long-term use 6.
- The risk of osteoporosis can be increased by factors such as smoking, excessive alcohol consumption, and hypogonadism 6.
- Patients with bone-on-bone arthritis should be carefully evaluated for the potential risks and benefits of corticosteroid use, and alternative treatment options should be considered 2, 5, 3, 4.