Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative

C Zeng; N E Lane; D J Hunter; J Wei; H K Choi; T E McAlindon; H Li; N Lu; G Lei; Y Zhang

doi:10.1016/j.joca.2019.01.007

Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative

Osteoarthritis Cartilage. 2019 Jun;27(6):855-862. doi: 10.1016/j.joca.2019.01.007. Epub 2019 Jan 29.

Authors

C Zeng¹, N E Lane², D J Hunter³, J Wei⁴, H K Choi⁵, T E McAlindon⁶, H Li⁷, N Lu⁸, G Lei⁹, Y Zhang¹⁰

Affiliations

¹ Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: CZENG6@mgh.harvard.edu.
² Center for Musculoskeletal Health and Department of Medicine, University of California School of Medicine, Sacramento, CA, USA. Electronic address: nelane@ucdavis.edu.
³ Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia. Electronic address: david.hunter@sydney.edu.au.
⁴ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: JWEI6@mgh.harvard.edu.
⁵ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: HCHOI@PARTNERS.ORG.
⁶ Division of Rheumatology, Tufts Medical Center, Boston, MA, USA. Electronic address: tmcalindon@tuftsmedicalcenter.org.
⁷ Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: lihui1988@csu.edu.cn.
⁸ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: leonana@bu.edu.
⁹ Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: lei_guanghua@csu.edu.cn.
¹⁰ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: yzhang108@mgh.harvard.edu.

PMID: 30703543
DOI: 10.1016/j.joca.2019.01.007

Abstract

Objective: A recent randomized clinical trial reported that repeated intra-articular corticosteroids (IACs) were associated with a greater cartilage loss. This study aimed to examine the relation of IACs to knee radiographic osteoarthritis (ROA) progression in a real-world setting.

Design: A cohort that initiated IACs and a comparison cohort without IACs from participants with mild to moderate knee ROA in the Osteoarthritis Initiative (OAI) were assembled (from 0-month to 48-month). Two measures of knee ROA progression were assessed during the follow-up period: (1) an increase in Kellgren and Lawrence (KL) grade by ≥1 grade or having a knee replacement (i.e., KL grade worsening); and (2) a decrease in joint space width (JSW) by ≥0.7 mm or having a knee replacement (i.e., JSW worsening). The associations of IACs initiation using a propensity-score matched cohort study and continuous IACs using marginal structural models with the risk of knee ROA progression were examined.

Results: Among 684 propensity-score matched participants at baseline (148 IACs initiators, 536 comparators), 65 knees (21.7/100 person-years) in the IACs initiation cohort and 90 knees (7.1/100 person-years) in the comparison cohort experienced KL worsening. The hazard ratios (HRs) of KL worsening from IACs initiation and continuous IACs were 3.02 (95% confidence interval [CI], 2.19-4.16) and 4.67 (95% CI, 2.92-7.47), respectively. The corresponding HRs of JSW worsening were 2.93 (95% CI, 2.13-4.02) and 3.26 (95% CI, 1.78-5.96), respectively. All HRs for continuous use of IACs were further away from the null.

Conclusions: IACs, especially continuous IACs, may be associated with an increased risk of knee ROA progression.

Keywords: Cohort; Corticosteroids; Osteoarthritis; Progression.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use*
Aged
Arthroplasty, Replacement, Knee / statistics & numerical data*
Cartilage, Articular / diagnostic imaging*
Cohort Studies
Disease Progression
Female
Humans
Injections, Intra-Articular
Knee Joint / diagnostic imaging*
Male
Middle Aged
Osteoarthritis, Knee / diagnostic imaging
Osteoarthritis, Knee / drug therapy*
Osteoarthritis, Knee / surgery
Propensity Score
Proportional Hazards Models
Radiography
Risk Factors

Substances

Adrenal Cortex Hormones