What’s the truth about cortisone? Does it work? Are alternatives more effective? And does it really cause long term joint damage? YKC’s Jim Newman explains.

You have osteoarthritis. Over-the-counter painkillers no longer have much of an effect. You’re exercising and managing your weight as best you can. But things haven’t yet progressed to the point where your consultant is recommending a knee replacement.

For years now, orthopaedic specialists have used cortisone as a stop gap for patients in this position. Injected at the site of the pain, the corticosteroid acts as a strong anti-inflammatory agent while dampening the immune system’s reaction that contributes to swelling and discomfort. Over weeks and often months, a cortisone injection can reduce the pain of osteoarthritis. We know that it’s effective, which is why it is used so frequently.

Is there a problem with cortisone?

If your knee pain is getting worse and you’ve been researching pain reduction alternatives, you’ve probably come across a recent study that found steroid injections like cortisone are linked to faster joint damage (that is, patients using cortisone showed more signs of arthritis progression) over time.

I speak with lots of patients who, quite reasonably, research their condition and treatment options online to help them make a decision. If you saw this study or any of the articles linked to it, you’d almost certainly think twice about cortisone. You may well start considering hyaluronic acid or other injectable treatments as an alternative, because the study found them to be the preferable option.

And here’s the issue: outside of the medical community there’s a perception that all medical studies are of equal weight – but they’re really not.

Does cortisone make osteoarthritis worse?

This isn’t the first study to claim that cortisone advances arthritis progression. Previous studies have rather overegged the pudding in their findings. This study wasn’t randomised (a common approach for studies with genuine rigour), which means there’s a risk of selection bias.

We can’t say for certain that has happened here, but look at it this way: the vast majority of patients only get a cortisone injection once their osteoarthritis is pretty well advanced. So even if there is some truth to this, the path is already set. The cartilage is already breaking down. A knee replacement will be the eventual treatment and a cortisone injection will help you get over flare ups. So what exactly would we be preventing by not using cortisone?

Does hyaluronic acid work?

Then there’s the issue of alternatives. The study found that “patients who received hyaluronic acid injections — a gel-like lubricant for joints — not only avoided signs of worsening arthritis, but actually showed reduced disease progression on MRI scans”.

That sounds impressive but flies in the face of lots of other data that show that hyaluronic acid injections are fairly pointless.

When should cortisone be used with caution?

This isn’t to say cortisone should be used willy-nilly. In elite athletes, for example, cortisone may be used as a quick fix to get someone back on track, pitch or court. In some instances, we’ve seen certain individuals using cortisone far too casually, and this gives real cause for concern.

That’s because, while a quick injection may get an athlete up and playing again, the cortisone may suppress the natural protective response that enables the injury to heal. Certainly, using injections in relatively healthy knees isn’t wise, but as we’ve seen, by the time most patients need the support of a cortisone injection, their knees are no longer healthy.

Talk to Yorkshire Knee Clinic

So where does that leave us? Certainly, I’d advise caution in assuming that one study is as reliable as another. The truth is that, if there was a reliably better alternative to cortisone, we’d be using it. That said, we’ll only ever use cortisone in patients likely to benefit from it, and that means they will already have advanced osteoarthritis.

Can we help you escape knee pain? Please contact us, or phone us on 03453 052 579.

> Find out more about Jim Newman
> Discover more about osteoarthritis, symptoms & treatments
> Discover more about partial or total knee replacements