Popular treatment for knee pain may not be as effective as once believed

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Knee osteoarthritis is common, impacting more than nine million people in the United States. Treatments aim to ease pain and improve function, and range from lifestyle management to joint replacement, with many options in between. Now, researchers have some surprising findings about one of the more popular treatment options, cortisone injections.

Dr. Elaine Husni of the Cleveland Clinic did not take part in the study, but says results show long-term use of cortisone knee injections may not be as beneficial as once thought.

"There was actually more cartilage loss in the cortisone-treated group than the saline placebo group," Dr. Husni says.

Researchers took 140 people with symptomatic knee osteoarthritis and assigned half of them to receive a cortisone injection, also known as a corticosteroid injection, every twelve weeks, while the other half received a saline placebo injection. 

After two years, results show there was no reported difference in long-term pain relief between the two groups. Both groups felt the same amount of pain and stiffness.

In addition, the group that received cortisone injections showed more cartilage loss in the knee. Cartilage cushions the ends of bones between joints.

When it wears away, the bones rub together causing damage and pain. Dr. Husni says the study is well done, but notes that long-term use of cortisone injections every twelve weeks is not typical. She says cortisone injections are typically used to reduce inflammati on during painful osteoarthritis flare-ups. She adds that the information is good to keep in mind, but shouldn't deter the occasional use of these injections. 

"Sometimes the knee osteoarthritis flares and they get to a point where the pain isn't tolerable and they need something to help sort of reset and so we use corticosteroid injections maybe in  that situation as a one-time treatment so that can bridge them to other non-operative treatments," she says.

This study published in JAMA points out you need to weigh the risks versus the benefits. Some will feel losing a small amount of cartilage is worth short-term pain relief.