Steroid Injections or not?

Dr. Weeks’ Comment: Arthritis – be it osteoporosis (wear and tear) or rheumatoid (auto-immune) or psoriatic (auto-immune and dermatological) hurts! But many treatments are worse than the illness.

I have never endorsed steroid injections because the risk benefit ratio does not support its use. Why? Because there are safer and more effective remedies like…. topical anti-inflammatory seed oils which soak right through the skin into the inflamed joints . Watch THIS and THIS and THIS for amazing examples of rapid pain relief. Also we have used topical honeybee venom therapy which is time honored anti-arthritis remedy that requires a epinephrine kit “bee sting” kit on hand.

Also steroid injections offer only temporary benefit which can be a helpful diagnostic aid but these steroid injections are not optimal because they only offer brief suppression of symptoms while, more ominously, masking the pain and creating the risk that the person will overuse and further damage the injected joint. In the elderly population, steroid injections also risk confusion “steroid psychosis” and depression. Best to eat and rub the anti-inflammatory seeds.

J Rheumatol. 2019 Apr 1. pii: jrheum.180233. doi: 10.3899/jrheum.180233.

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Maricar N1Parkes MJ1Callaghan MJ1Felson DT1O’Neill TW1.

Abstract

To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections(IASI) in symptomatic knee OA.

METHODS: 

Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.

RESULTS: 

One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders.

CONCLUSION: 

Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.