Progression of Knee Osteoarthritis with use of Intra-articular Corticosteroids vs. Hyaluronic Acid

Objective To determine whether intra-articular corticosteroid injections are associated with increased knee osteoarthritis progression compared to hyaluronic acid injections which has been reported to delay OA progression and knee replacement. Methods We identified participants from two large cohort studies, the Osteoarthritis Initiative and the Multicenter Osteoarthritis Study. Study visits were performed at regular intervals and included questionnaires about intraarticular corticosteroid or hyaluronic acid injection use in the previous 6 months, incident total knee replacement and knee radiographs, which were obtained and interpreted in similar fashion. Outcomes were radiographic progression based on Kellgren and Lawrence grade and joint space narrowing for both cohorts; medial joint space width for Osteoarthritis Initiative participants; and incident total knee replacement. We compared pre- and post-injection x-rays to generate rate ratios of progression comparing corticosteroid injection with hyaluronic acid users. A Cox proportional hazards model was used to estimate rate of total knee replacement for both groups. Results We studied 791 participants (980 knees) with knee osteoarthritis, of whom 629 reported CSI use and 162 HAI use. Rate ratios of progression were similar between corticosteroid and hyaluronic acid injection users for Joint Space Narrowing (1.00 [95% CI 0.83-1.21]), Kellgren and Lawrence grade (1.03 [95% CI: 0.83 - 1.29]) and medial joint space width (1.03 [95% CI 0.72 - 1.48]). Hazard of total knee replacement was slightly lower for intraarticular corticosteroid compared to hyaluronic acid users (HR 0.75, 95% CI 0.51 - 1.09). Conclusions Intraarticular corticosteroid injections are not associated with increased risk of progression compared to hyaluronic acid.