Study Links Intra-Articular Corticosteroid Use to Accelerated OA Progression on MRI
A secondary analysis of Osteoarthritis Initiative (OAI) data published in Radiology, has found that intra-articular corticosteroid injections are associated with significantly greater progression of knee osteoarthritis (OA) as measured by MRI over a 2-year period, when compared with both hyaluronic acid (HA) injections and matched controls.
The retrospective cohort analysis evaluated 210 participants (mean age, 64 years; 60% female) from the OAI who had undergone either corticosteroid or HA injections. Propensity score matching accounted for age, sex, BMI, and baseline clinical characteristics. OA progression was measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) for cartilage, bone marrow lesions, and meniscal pathology at three time points: two years prior to injection, at the time of injection, and two years after.
Key findings showed that corticosteroid injections were associated with a statistically significant increase in WORMS progression compared with both control participants (mean difference, 0.39; 95% CI: 0.05–0.75; P = .02) and those receiving HA (mean difference, 0.42; 95% CI: 0.01–0.84; P = .04). In contrast, HA injections were associated with decreased OA progression when compared to the injection-concurrent timepoint (mean difference, −0.42; 95% CI: −1.34 to −0.28; P = .003).
The study’s authors emphasized, “Corticosteroid injections were associated with higher OA progression than HA injections and controls,” suggesting a potential long-term adverse impact on joint integrity from corticosteroid use.
Despite these structural findings, both corticosteroid and HA injections offered statistically significant symptomatic relief. Post-injection improvements in WOMAC pain scores were noted in both groups, with corticosteroids offering a greater reduction (−5.20; 95% CI: −6.91 to −3.48; P = .001) compared to HA (−2.15; 95% CI: −4.42 to −0.13; P = .04).
For rheumatologists, this study underscores a critical consideration: while corticosteroid injections may deliver short-term pain relief, they may accelerate structural joint deterioration over time. “HA was associated with decreased progression at MRI for up to 2 years after injection,” the authors noted, making HA a potentially safer long-term strategy for symptom management in knee OA.
This evidence may inform treatment decisions, particularly for patients requiring repeated intra-articular interventions. MRI-based outcomes provide a compelling dimension beyond clinical symptom tracking, highlighting the need to weigh immediate pain relief against potential structural harm.
Reference
Bharadwaj UU, Lynch JA, Joseph GB, et al. Intra-articular knee injections and progression of knee osteoarthritis: data from the osteoarthritis initiative. Radiology. 2025;315(2):e233081. doi:10.1148/radiol.233081
