It's been a full 90 years since Dr. Philip S. Hench and his colleagues from the Mayo Clinic discovered cortisone can be effective in the treatment of rheumatoid arthritis.

Cortisone was first prescribed for rheumatoid arthritis in 1949, or 70 years ago, after it was first produced commercially by Merck & Co. in 1948. In the seven decades since, hundreds of millions of people around the world have had cortisone shots for short-term pain relief and to reduce the swelling from both rheumatoid arthritis and osteoarthritis.

Worldwide, corticosteroid injections into the hips and knees remain a common treatment for patients in significant pain. One study revealed that half of more than 16,500 patients that underwent knee or hip joint replacement received corticosteroid injections in the previous two years.

Today, however, new and dismaying research reveals that corticosteroid shots in the hips and knees might instead accelerate the progression of osteoarthritis. Corticosteroid shots might potentially even hasten the need for joint replacement surgeries in the long run, according to a study published in the journal, Radiology, led by the Boston University School of Medicine (BUSM).

“The intra-articular corticosteroid injections in the hips and knees are not as safe as we thought,” Dr. Ali Guermazi, study lead author and a professor of radiology at BUSM, said.

Dr. Guermazi said corticosteroid injections might be detrimental in the long run despite temporary pain relief.

“They may actually harm your knee or your hip,” he said.

In the study, researchers reviewed existing literature on corticosteroid injections for osteoarthritis. They also looked at data on 459 patients at Boston Medical Center that received one to three corticosteroid injections in the hip or knee in 2018.

Researchers found that eight percent of patients developed complications in the two to 15 months following the injections. These complications include stress fractures, bone deterioration, cartilage loss and joint destruction.

The rate of complications surprised the researchers. They surmised this figure might actually be an underestimate because 218 of the patients didn't have follow-up imaging tests to assess the health of their joints.

Dr. Guermazi said an exact explanation for the findings is unclear. There is, however, some evidence corticosteroid injections can be toxic to cartilage. More studies are needed to understand their effects and clarify their benefits and risks.

rheumatoid arthritis
Adding to a laundry list of ailments, researchers find rheumatoid arthritis is twice as common in Ground Zero first responders. handarmdoc, CC BY 2.0