Current management of
osteoarthritis (OA) is primarily focused on symptom control. Intra-articular
corticosteroid (IACS)
injections are often used for
pain management of hip and knee OA in patients who have not responded to oral or topical
analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral
insufficiency fracture, complications of pre-existing
osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS
injections. This expert panel report reviews the current understanding of
pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or
laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS
injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included.