Cortisone Shot or Not?
Corticosteroid shots have been used for many decades now for treating pain in many joints. Corticosteroid is known to provide short-term symptomatic relief in some patients for knee arthritis, inflammation, hip bursitis, shoulder pain, etc. There is a lot of evidence that supports the short term relief and improved quality of life for 6-9months. But the long-term evidence shows some potential adverse effect of repeated corticosteroid injections, such as, disrupted collagen repair and increased risk of tendon rupture. But getting back to the knee there has not been much high level research looking at the long-term effect of repeated corticosteroid shots and its effect on the collagen cartilage in the knee. In May 2017, there was an article published that reported on the long-term repeated exposure to multiple corticosteroid shots over a two year period. There was two groups of participants who were all diagnosed with similar levels of knee osteoarthritis. One group was given a corticosteroid injection every 12 weeks and the other group was given a saline injection without corticosteroids every 12 weeks. Both groups had no idea to which group they were assigned. This type of research design results in the highest quality of evidence also known as a Randomized Controlled Trial. The results of this trial indicated that corticosteroid treatments led to a greater loss of cartilage at 2 years compared to the saline group, with no significant differences in pain outcomes between groups. There were some limitations to this study. There were only 140 participants which was not a large enough group to make clinical guideline changes. Also the treatment providers may not have be adequately blinded to the type of injection they were giving, which could bias the treatment effect. However, there is significant high quality evidence coming out of Denmark on the effect of Hip and Knee osteoarthritis management using Physiotherapist led group-based exercise and education.
How to chose the best treatment?
1. Ask your clinician about the short and long-term risks and benefits 2. Ask what it will feel like 3. Ask about alternate treatment options 4. Ask how long the effect will last