"We've been telling patients that even if these injections don't relieve your pain, they're not going to hurt you," said co-author Dr. Ali Guermazi of BUSM's Department of Radiology and the Veterans Affairs Hospital in Boston.
"But now we suspect that this is not necessarily the case," added Guermazi.
Cortisone shots are also called corticosteroid or steroid shots. These are anti-inflammatory medications commonly injected into joints to treat the pain and swelling associated with osteoarthritis and rheumatoid arthritis. Before the study, the procedure was widely considered safe, and while patient consent forms mention the risk of hemorrhage and infection, these side effects were thought to be rare.
However, recent studies are beginning to chip away at this assumption as findings have suggested that cortisone injections may be frequently associated with adverse effects on the joints. The researchers reviewed these studies as well as the health records of nearly 500 patients who had been injected with cortisone in the hips and knees in 2018.
After analyzing the existing literature, the researchers identified four main adverse effects: accelerated osteoarthritis combined with the loss of joint space, the development of stress fractures beneath the cartilage, the death of bone tissue and rapid joint destruction including bone loss.
The researchers also found that eight percent of the patients experienced complications, with 10 percent of them receiving the injection in the hips and four percent in the knees. (Related: Steroid use linked to increased risk of bacterial and viral infections.)
"Physicians do not commonly tell patients about the possibility of joint collapse," said Guermazi. "This information should be part of the consent when you inject patients with intra-articular corticosteroids."
The researchers also recommended physicians monitor patients who are referred for cortisone injections to treat joint pain but display mild or no osteoarthritis based on imaging results. Previous studies showed that these individuals are at risk of progressive joint space loss or destructive osteoarthritis after injection.
The team said that a planned injection may need to be reconsidered especially when the patient has an acute change in pain that's not explained by imaging findings. They said that an underlying condition may be responsible for joint pain.
"[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," added Guermazi.
The following therapies may offer natural pain relief to those with arthritis:
Consider these natural alternatives to boost your joint health and prevent the adverse effects of cortisone injections. Learn more about natural pain relievers at Remedies.news.