OSTEOARTHRITIS AND STEROIDS

BY FRED G. ARNOLD, NMD

Using steroids to treat painful arthritic joints have been used in orthopedics and sports medicine for more than 50 years and the anti-inflammatory effects of corticosteroids have been well established. Corticosteroids injections can provide prompt and effective relief of pain within a few hours after the injection and can last a few days or a few weeks.

Osteoarthritis (OA) is also known as degenerative arthritis, degenerative joint disease or osteoarthrosis. A characteristic feature of osteoarthritis is a breakdown of cartilage between the bones at the joint with associated joint pain. Other symptoms may include joint swelling and decreased range of motion. Although any moveable joint can be affected, the most common joints to be affected are the knees, hips, lower back neck and fingers.

Although there is no consensus as to why osteoarthritis occurs, factors influencing include sex (women, especially after entering menopause), low hormone levels, nutritional factors, obesity, ligament laxity, joint misalignment, and trauma.

Even though there has been evidence a few years after doctors started using steroid injections into a joint causing increases destruction of joint cartilage, their use has increased as an orthopedic standard of care for painful joints.

Human and Animal Studies
Both human and animal studies have shown adverse effects of corticosteroid injections. As little as one steroid injection into a joint as shown deleterious effects on cartilage and the higher the dose, the worse the deterioration. Temporary and permanent damaging changes in soft tissue, bone and joint cartilage have long been reported. Researchers have found that corticosteroids injected into human osteoarthritic joints accelerate articular cartilage degeneration, as confirmed by X-rays, and they deteriorate joint function compared to non-injected knees.

Forty years ago, in an Editorial for the British volume of the Journal of Bone and Joint Surgery, “We now have evidence, both clinical and experimental, that apart from the well recognized hazard of infection, intra-articular injections of corticosteroids, certainly, if repeated, may be harmful, yet the practice has continued. We believe that it should now cease”. This sentiment is reiterated by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine who state, “Although an extremely useful technique, the intermittent use of intra-articular cortisone should be deployed with caution”.

Known Effects of Intra-articular Corticosteroids on Articular Cartilage
Studies have shown the destruction of articular cartilage is the greatest when there has been a higher number of injections and when the dose is the higher. Destruction of the joint is worsened over time and with exercise. Receiving a steroid shot to allow strenuous or perform exercise activities, causes further damage to the joint. Corticosteroids cause damage to the cartilage forming cells with destruction and thinning of joint cartilage with a decrease in cartilage cell growth and repair.

Common Steroid Medications
Some of the more common oral and injectable steroid injections include decadron, depo-medrol, kenalog, kenacort, medrol, methylprednisolone, and prednisolone.

Other Side Effects of Steroids
In addition to destruction of joint articular cartilage, other common side effects of steroids include cataracts, insomnia, lower resistance to infection, muscle weakness, osteoporosis and water retention.

Alternatives to Steroids
It is the responsibility of the patient to make themselves aware of the dangers and alternatives to steroids:

1. Other Pain Medications: there are pain medications that are not anti-inflammatory and they do not cause the breakdown of articular cartilage. Tylenol (acetametaphin) is an example of an over-the-counter pain medication and there are numerous prescription pain medications that are not anti-inflammatory that can be prescribed.


2. Limit the dose and time period steroids are taken: take the smallest dose possible for the shortest period of time.  Steroids at higher dosages and taken for extended periods of time will cause joint damage.


3. Consider Natural Alternatives for the treatment of joint inflammation:  there are many natural alternatives to steroids that includes an anti-inflammatory diet and numerous supplements such as fish oil, Vitamin D, resvesatol, and curcumin.
4. Address the Varied Causes of Osteoarthritis: overweight, hormone imbalance , weakened ligaments, nutritional factors, joint misalignment.


5. Regenerative Medicine Injections:  there are proven regenerative medicine injections to regenerative and repair arthritic joints such as prolotherapy, prolozone, platelet rich plasma (PRP) and stem cell therapy.

Conclusion:
Despite the fact that substantial scientific evidence exists indicating detrimental effects of corticosteroids with no long term benefit, clinicians continue to use intra-articular corticosteroids in the treatment of osteoarthritis. These injections result in severe deleterious effects, both mechanical and physiological, on the joint and articular cartilage. The net result of corticosteroid joint injections is an acceleration of the osteoarthritic process which is manifested in the dramatic rise of cases of osteoarthritis of the knee and hip and subsequent joint replacements. There are alternatives to steroid injections that may offer relief of painful arthritic joints without the dangerous side effects of steroid injections. Since many doctors may not offer alternative treatments to steroid injections, it the patient’s responsibility to ask and learn about other treatment options and their potential risks and benefits.

Reference:
Hauser, Ross A., The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections, Journal of Prolotherapy, Volume 1, Issue 2, February 2009.