A leading rheumatologist has said it will be a tragedy if the fallout from a widely reported study that questions the long standing practice of intra articular steroid use for knee OA results in doctors denying patients pain relief with the therapy.
The study of 140 patients published in JAMA revealed that patients with knee OA who had received injections of a corticosteroid every three months over two years were left with significantly greater cartilage volume loss and no significant difference in knee pain assessed at 3-month intervals compared to control group patients who received a saline injection.
As reported by the limbic last week (see story here), the findings led several prominent rheumatologists in Australia to question the practice and call for its long-term use to be ‘actively discouraged’.
But rheumatologist and epidemiologist at Boston University in the US, Dr David Felson, told the limbic he doesn’t agree with the strong conclusions drawn from the paper and has questioned some elements of the study’s design.
“Three month pain effects were studied in this trial and not effects earlier after the shot, he told the limbic over email.
“Intra-articular steroids are a highly effective short term treatment for knee OA. Multiple studies including this one have shown that the effect of these shots usually does not last for 3 months – the maximal effect is at 1-4 weeks after the shot, especially if a low dose is given as was the case in this study.”
He also argues that the cartilage volume loss observed in the treatment arm of the study – 0.1 mm over two years – is unlikely to be clinically important.
“The effect on cartilage volume seen is almost certainly trivial … it would be a tragedy if this study were used to discourage patients in pain from getting this highly effective treatment.
He says repeated injections of steroids are likely to be ‘fine’.
“The most important element of treatment for OA is pain relief and, to the extent that this treatment provides such relief, it is a valuable option.”