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Cortisone injections may accelerate arthritis, study finds

Steroid injections given to tens of thousands of arthritis patients to relieve them of their pain ‘may actually ACCELERATE their crippling condition’

  • Boston University researchers looked at 450 patients who had shots in last year 
  • Eight per cent of them saw their arthritis get worse within 15 months of injection
  • More than 70,000 people in the UK have at least one cortisone shot per year

Common steroid injections used to treat arthritis may actually make the degenerative condition worse, a study suggests.

Researchers found that while effective in treating pain, cortisone jabs can speed up a joint’s disintegration and force patients to have full knee or hip replacements.

They looked at more than 450 patients with osteoarthritis, the most common type of arthritis that causes joints to become painful and stiff.

The team of academics from Boston University found 8 per cent of people saw their arthritis get worse within a year.

They say the drug may damage cartilage within the joint and make it weaker and more susceptible to wearing down.

A study by the University of Boston has found that cortisone shots may actually accelerate arthritis (file)

But they claim more research needs to be conducted to discover why the steroid causes further damage in some cases. 

The scientists have called for consent forms to be handed to patients which detail the potential dangers found in their study.

They also recommend sufferers with less severe symptoms to avoid getting the shots.

Cortisone injections, which have an effective pain numbing effect, are also popular in professional sports and used to help athletes play through the pain barrier.

But they are most commonly used to treat osteoarthritis, which affects around 8million people in the UK and 31m in the US. There is no cure for the condition.

More than 70,000 people in the UK have at least one cortisone shot per year, but many have up to three.

Research suggests the procedure costs the NHS nearly £40 million every year. The procedure was generally viewed as safe but patients are made to sign a consent form.

The document largely warns of side-effects common with most injections – like infection.


Osteoarthritis – sometimes called ‘wear and tear’ – is a condition that occurs when the surfaces within joints become damaged.

Cartilage covering the ends of bones gradually thin over time, and the bone thickens, according to Arthritis Research UK.    

Around a third of people aged 45 years and over in the UK suffer from the condition. This equates to roughly 8.75 million people. At least 20 million are known to suffer in the US.

It is different to rheumatoid arthritis, a long-term illness in which the immune system causes the body to attack itself, causing painful, swollen and stiff joints.  

Replacement joints are often necessary for osteoarthritis patients, because the joint has been worn down and causes agonising pain.

Researchers from Boston University School of Medicine looked at 459 patients who had corticosteroid injections in their hip or knee at the hospital in 2018.

The participants were aged between 37 and 79. Scientists found that 36 patients (8 per cent) had complications down the line – 19 women and 17 men. 

Thirty patients had the jab in their hip, while six had it in their knees. Twenty-six patients (6 per cent) saw their osteoarthritis accelerate and worsen within a year.

Four patients (0.9 per cent) suffered stress fractures – a break in the bone caused by accumulative damage – on their hips or knees.

Three people (0.7 per cent) experienced rapid joint destruction which resulted in bone loss, while another three patients suffered complications with osteoarthritis. 

Lead author Dr Ali Guermazi, a professor in radiology, said: ‘We’ve been telling patients that even if these injections don’t relieve your pain, they’re not going to hurt you. But now we suspect that this is not necessarily the case.’

He called for consent forms to detail the new dangers found in his team’s research.

The professor added: ‘Physicians do not commonly tell patients about the possibility of joint collapse or subchondral insufficiency fractures that may lead to earlier total hip or knee replacement.

‘This information should be part of the consent when you inject patients with intra-articular corticosteroids.’

The researchers recommend that patients receiving shots with little sign of osteoarthritis on an X-ray are carefully monitored – especially when the pain they experience is disproportionate to what’s visible on the scan.

These patients, they point out, are at greater risk of destructive arthritis after injections. 

Most importantly, the team state that younger patients must be told of the potential consequences of an injection before they are given it.

The widespread use of corticosteroid injections – particularly in professional sport – means the potential of the study are enormous, Dr Guermazi believes.

He added: ‘Intra-articular joint injection of steroids is a very common treatment for osteoarthritis-related pain, but potential aggravation of pre-existing conditions or actual side effects in a subset of patients need to be explored further to better understand the risks associated with it.

‘What we wanted to do with our paper is to tell physicians and patients to be careful, because these injections are likely not as safe as we thought.’