Friday, May 26, 2017

Forget Steroid Shots for Long-Term Relief of Arthritic Knees

Steroid shots are a common treatment for arthritic knees. But, a new study says their long-term use is ineffective and may even reduce cartilage.

Knee osteoarthritis patients who got steroid injections every three months for two years had no less pain than those taking a placebo treatment. And they had greater loss of cartilage, the rubbery tissue that acts as a cushion between the bones of the joints, researchers found.

“This research will change how I talk to patients,” said Dr. Seth Leopold, a professor of orthopedics and sports medicine at the University of Washington School of Medicine. “I will tell patients that the best information we now have suggests that these injections may not help, and extended use may thin your cartilage,” said Leopold, who wasn’t involved in the study.

Osteoarthritis is the wear-and-tear form of the joint disease, characterized by pain, swelling and stiffness. Knee arthritis is a major cause of disability, affecting more than 9 million Americans, according to the background notes with the study.

Steroid shots in the knee joint are commonly given as a short-term treatment for pain flare-ups, and they can be useful for that purpose, said study lead author Dr. Timothy McAlindon. He’s chief of rheumatology at Tufts Medical Center in Boston.

For the new study, researchers tracked 140 patients, age 45 and older, who had arthritis knees with inflammation of the synovial membrane – a thin membrane lining the joint. The patients were randomly assigned to receive injections with either a steroid (intra-articular triamcinolone) or saline.

At the end of the study, pain levels didn’t differ significantly between the two groups, according to the study. “It did not have an effect on long-term pain, and it didn’t reduce the progression of the disease,” McAlindon said. But patients in the injection group lost significantly more cartilage thickness than those in the saline group.

Leopold, however, said the thinning of cartilage is less important for older patients whose knees are already severely arthritic. For them, he said, “it probably doesn’t matter.”

The researchers reported their findings in the May 16 issue of Journal of the American Medical Association.

My Take:
The meniscus of the knee or cartilage is the shock absorber of the joint. Regardless of the level of arthritic degeneration, thinning of these structures does matter.

The “wear-and-tear” theory of osteoarthritis is somewhat outdated. It is now believed that the constant wear on a joint doesn’t damage the surface of the bone as previously thought. Rather, the concussive force damages the microcirculation of the joint. It is the loss of circulation to the bone that causes the osteoarthritis.

However, mild concussive force actually increases circulation to the joint as evidenced by the new study that shows running can actually keep the knee healthy.

Most of my patients with osteoarthritis of the knee have degenerated from lack of activity rather than wear-and-tear.

The Bottom Line:
Osteoarthritis of the knee is better treated with natural anti-inflammatory supplements like fish oil, Turmeric, ginger and Boswellia than steroids. I also like to promote circulation to the knee with Gingko and grape seed extract. The Gingko must be used with caution as it has several drug interactions with the medications frequently given to our aging population.

Source: May 16, 2017 National Institutes of Health

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