Hrm. So if you are in less pain you walk more and your joints wear out faster. Seems more like correlation than causation to me. YMMV.

I thought this was already well-known. I had to have a steroid shot in my knee in 2016 and the doctor warned me that it couldn’t be done too often as it would hasten degeneration.

• More than 32 million U.S. adults suffer from the condition, which most often affects the hands, the hips and the knees. There is no cure, but the discomfort is sometimes treated with corticosteroid shots. Hyaluronic acid injections are also used, although they’re less likely to be covered by insurance.

• Two new unpublished studies suggest that patients who got corticosteroid shots saw their knee arthritis advance more quickly than those who didn’t.

• Both studies assessed patients from the Osteoarthritis Initiative, a yearslong observational research project involving nearly 5,000 people with knee osteoarthritis. Darbandi’s research analyzed X-rays from 50 patients who got corticosteroid shots, 50 who got hyaluronic acid and another 50 in a control group. The scans, collected annually for four years, revealed worse arthritis progression among participants injected with corticosteroids compared to the other two groups.

• “Knowing (faster deterioration in those using steroids) that helps patients make a more informed choice about if they want an injection and, if they do, which injection they might prefer,” said Dr. Upasana Bharadwaj, a postdoctoral researcher in UCSF’s radiology and biomedical imaging department who co-authored the study.

• Dr. Jonathan Samuels, a rheumatologist at NYU Langone Health, said it’s tough to determine causation in studies like the two new ones, because many factors can influence the progression of arthritis and no two patients are the same.

• Dr. Jason Kim, vice president of osteoarthritis research programs at the Arthritis Foundation, said he’d want to see studies with a “much higher sample size over a longer period of time” before considering possible causal links.

• Bharadwaj and Darbandi agreed that more research is needed, as are peer reviews for their studies.

• Bharadwaj noted that her team did try to control for the possibility that people who got steroid shots were simply more likely to engage in activities that furthered the progression of their arthritis afterward. To do so, they selected participants who had maintained similar activity levels throughout the study period.

• Darbandi offered a few caveats to keep in mind alongside the findings. One, he said, is that the results don’t necessarily indicate the severity of symptoms patients experienced. Just because imaging shows more arthritis progression doesn’t mean a patient feels more pain. And second, he said, the results shouldn’t lead people to avoid corticosteroid shots in all situations.

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it is possible. experts outside of the study says too early to determine causation bec in OA a lot of factors come into play and as you say YMMV. a more extensive (bigger sample lot and longer period) would help ascertain these recent findings.

Indeed, I suspect the most common reason people get such corticosteroid shots is for short-term ability to continue working. From my very limited personal experience, there was never any understanding this was good for the long-term.

steroids blocking healing is a known issue. too bad they didnt gave a steroid plus HA group

I’m thankful that it was just for bursitis and not for a chronic condition. But the sheer number of people I see hobbling around… gah.

The irony is my docs have made me get them before they’ll try something else. Cortisol shots have only ever made my joints angrier, then back to where I was. Haven’t helped even one time

There are exercises you can do to lessen joint pain.

I had a tendon rip through a sheath - from what I’ve read it was from stress tension.

I’ll never be able to play acoustic guitar again.

It’s stress tension, I think.

Steroid do dick all for tissue healing but do everything for inflammation.

Is there any data on hyaluronic acid shots?

Yes, it’s well known.

That's why you're seeing people revert back to prolotherapy to reduce inflammation and promote healing.

only that in comparison w steroid shots, “hyaluronic acid injections were associated with slower progression of the disease relative to a control group.” (in the 2nd study 26 patients were given the HA and their corresponding MRI scan showed less severe cartilage deterioration vs those in steroid grp)

as i understand the two studies will be presented this week Radiological Society of North America’s annual meeting.

My mother took cortisol shots too for her wrist, worked for like 5 months for her and now it doesn't and her wrist hurt even more

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yup - offers instant relief to pain/inflammation but perhaps must not be given for long term use if the risk outweighs the benefit of the treatment.

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"Two small unpublished studies." Why do people share this crap?

There was a study a few years ago demonstrating no statistical difference after 3 months between steroid and sham for knee arthritis, although the steroid gave short term relief. Not at my computer but I can try to dig it up.

That’s awesome! I think my family is genetically cursed to react badly to it. Mom is the same way with cortisol, does nothing for us but make it worse.

I know I lack a specific enzyme to use ibuprofen, I wonder if it’s the same thing for the steroid shots

> YMMV

Ain’t it the truth

unless you are a rich guy with an in pocket doctor like my ex, who wanted a shot before playing tennis... blech.

BBRBZ, not because these have yet to be published means they don't merit an audience or platform.

fyi, the two studies will be presented this week Radiological Society of North America’s annual meeting. perhaps the authors prefer to first unveil their work within their Society then later to the greater public.

I got my one and only shot in 2014. By 2018 I had to have a partial knee replacement on that knee. By October of this year that knee is now a full rotating hinged joint replacement.

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Had a TA shot in my knee (1st time) a week ago after an attempted draining, and it did not do crap for me and made it worse. No OA Dx yet or anything RA related and my doctors are clueless on what to do next. Guess I will not have to worry or have a reason to get another one.

Actually…your insurance provider won’t pay for a viscosupplement shot ($500+) until you have a cortisone shot ($10).

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Had a bad cuff tear. Surgeon wanted to give me a shot on the joint before an mri and send me on my way. I insisted on the MRI refused the shot. Turned out to be an almost full cuff tear and during surgery they saw a perfect smooth surface at the joint so no arthritis. The shot would have fucked me and solved nothing.

I find it absolutely absurd that insurance companies are able to override doctors and dictate medical treatment. Doctors actually went to school for medicine and are much more qualified to know what is needed, insurance should be barred from this practice, it should really be considered practicing medicine without a license.

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My mother was in so much pain from arthritis in her knee that she was admitted to hospital.

Doctor said there wasn't much they could do apart from managing the pain. My sister pressed back, saying there must be something he could do.

He said that cortisteroid injection in the knee was an option, but there could be long term complications.

Mum, "I'm 90, I don't have a long term!"

She got the injection and it worked.

She was also right, she only had another four years - but they were pain free years.

I’m sorry for your loss, but I’m glad she had the last few years without pain. Her memory for a blessing.

Wow, that’s bad practice. Thank goodness you insisted. Well done being an advocate for yourself!

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Complete pseudoscience quackery

Responsible doctors absolutely would warn against this I agree. Steroids deteriorate bone mass. Unfortunately it caught on as a "safe" alternative to opiates. It was insisted that I must try injections before we could consider opiates since I failed Gabapentin/ Lyrica with flying colors and I'm horrendously allergic to Aspirin and therefore NSAIDs. I would kill to be able to take ibuprofen. I received the shots in my knees even though my osteoarthritis was mild they were willing to do it monthly if necessary. Treatment resistant autoimmune inflammatory arthritis is my main issue though and my knees rarely hurt. They injected a steroid so strong that when it's put in flesh there is a risk of necrosis. I almost completely lost the ability to walk for six months and my knees were now the most painful part of every day for half a year. I slowly regained strength and the pain faded as the medication was fully absorbed and removed. I said never again. Eventually I did jump through enough hoops to get the opiates two rheumatologists suggested would be the only way to improve my quality of life. They were right as the last two years are going the best they have in over a decade. I'm literally a poster boy for the pain practice's success stories now.

Lots of people are forced to trade their health for a paycheck with long hours and little to no healthcare along the way. Then they get to retire after their best years are gone. It's a sad state of affairs.

My insurance still won't pay for it even though I had a bad reaction to steroid injections. They claim the research doesn't support HA shots as being effective. Would cost me thousands out of pocket at a drs office.

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That’s exactly what my PT said.

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What are these exercises?

I’m so sorry that they did that to you. Opiates are now treated like Satan by a lot of people, even professionals, and it’s horrific.

Gabapentin really works for some people (and my dog) - but it gave me suicidal ideations and then I had to be weaned off of it and it made the pain worse.

I am glad that you finally got the treatment and relief you need. All the best, friend.

Well your PT is right.

FWIW - insurance companies typically do base their decisions off of medical evidence/papers/science. I wanted to get a vicosupplement shot in my shoulder 5 years ago and insurance wouldn't cover it, but they would cover it if it was in my knee and not my shoulder.

Turns out there isn't great evidence for the shot working in a shoulder joint but there is evidence for it working in the knee. By evidence I mean an actual scientific paper/experiment that is run on the treatment that proves the treatment is effective.

I am sure there are plenty of business decisions that do come up though that a doctor should have more discretion over and not the insurance company.

Also in the article

> Dr. Jonathan Samuels, a rheumatologist at NYU Langone Health, said it’s tough to determine causation in studies like the two new ones, because many factors can influence the progression of arthritis and no two patients are the same.

> “We don’t have the biology to prove that the injection itself is causing accelerated damage. It’s hard to connect the dots from injection to damage from this preliminary data,” he said. “But it’s an important question, because it’s such a common practice to be injected with steroids.”

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Lot of talk of docs over-prescribing cortisone shots, but it's partly our fault too. We want that tangible, immediate fix--a "cure," rather than months of rehab, weight loss, exercise, lifestyle changes, etc. Hell, I've taken the shot just to get through a performance--and later spent months rehabing that joint to near new. But I don't think a shot every 10 years is causing much damage.

From a scientific/therapy standpoint, the increased arthritis in this case could partly be people continuing the behaviors that sparked the arthritis in the first place--without the usual pain/inflammation, they don't take extra care (OP's comment elsewhere highlights this too).

Sadly they don’t work for me. I’m sincerely jealous of those who it does work for.

My problem with insurance is that when everything proven fails, they still won’t pay for alternative treatments. Like what do they expect me to do at that point?

Most medical treatment is supposed to be backed by science. And from the insurance companies perspective, why would they pay for something that has no scientific evidence of working?

I agree mostly with your perspective here but I also see some bullshit cases of people having their doctor vouch that an operation is medically necessary and their insurance company begging to differ, it just sounds like they’re folding their arms and saying “nah” so they don’t have to pay out — shouldn’t it be like doctors notes for your employer, in that your doctor is trusted and qualified to make these kinds of decisions case-by-case?

smh, this has been a known fact for decades now.

I have always advised my clients to avoid cortisone injections if at all possible, as it is known to cause degradation of tissues in the joints systemically.

tl;dr: not "news"

With the decline in science reporting (not that it was ever great) and the I-did-my-own-research crowd being more influential than ever, I wish professional organizations would keep this stuff to themselves before peer review and publishing. Even that is no guarantee of quality, but the vast majority of lay people don't understand the limitations of preprints or preliminary reports like this. There is such a thing as too much information.

Totally agree

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This is absolutely true. Due to long term steroid use for other health related issues, prednisone GAVE me osteoporosis, arthritis, Addison’s disease, pre-diabetes, shut down my adrenal gland, BUT it has kept me alive!! There wasn’t a lot known about the steroid family 30 years ago, now there is. So, seriously, if you can avoid it, please do! It was a blessing and is a curse.

The real benefit from opiates for osteoarthritis might be that as the osteoarthritis grows bone nodules in an arthritic joint, the patient won't mind the pain of having to move so that the bone nodules get ground down to a smooth joint surface.

Just be honest about your pain, you owe it to yourself and the prescriber to do what is therapeutic, I'm sure that you know why. I'll never forget the time that I consulted with a different specialist, an emeritus at a prominent teaching hospital. I told him about my pain management, and he asked to see the medication. It was like I just handed superman a bottle of kryptonite, the poor guy was clearly tempted to gulp down a bunch of pills, or suffering some other anxiety about some measly Vicodin. A foremost healer in his field, and painkillers could maybe derail it all.

Really not going to fix capsular cartilage though

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They expect you to just go away. Honestly that’s why insurance will give the runaround on things. They hope you will get frustrated and give up.

Agreed. It's the reason I turn them down every time when offered.

Literally says in the article that they controlled for what you just said. Mb read the article.

Summary: Cortesone shots might relieve pain in knees but speed up joint issues.

Me neither. I had doctors trying to give them to me for years for nasty flairs of joint pain mostly in knees and shoulders. I know they don't work and they hate it when you don't follow their suggested course of action. After about 20 years of that I finally found out I have a hereditary disorder with joint pain similar to arthritis being a primary symptom. Steroids wouldn't have helped and would have just made things worse.

I get it, but if there is any chance of it working, I’d appreciate it if they recognized that it is in their better interest (and mine!) than me having surgery every two years, or being on a ton of medication, or getting steroid shot after steroid shot.

As if I have the option to give up! I guess they’d rather have me dead. Genuinely feels like they are trying to drive me to that sometimes.

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Yup. I'm currently helping my mother finally take care of herself - double hip replacement, teeth pulled, dentures, hearing aids, cataract surgery.... She didn't take care of herself at all during her life.

Massage is not going to change any condition that is relevant here

This is new? I thought that’s the reason cortisone injections were last resort?

Yes this is well known. It's a side effect of the shot.

Gawdamighty, for anything stronger than Advil here, it takes an act of god. Now. Before that, every junkie on the streets had a SAFEr Supply of oxy.

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I just had a knee replacement after 4 shots in the last year. Hope I'm good.

use alcohol and weed...much more effective with benefits