Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Zeng, C.; Lane, N.E.; Hunter, D.J.; Wei, J.; Choi, H.K.; McAlindon, T.E.; Li, H.; Lu, N.; Lei, G.; Zhang, Y.
• Is Part Of: Osteoarthritis and cartilage. Volume 27:Issue 6(2019)
• Page Start: 855
• Page End: 862
• Publication Date: 2019-06
• Subjects: Corticosteroids -- Osteoarthritis -- Progression -- Cohort; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Arthrose -- Périodiques; Articulations -- Maladies -- Périodiques; 616.7223005
• DOI: 10.1016/j.joca.2019.01.007
• Languages: English
• ISSNs: 1063-4584

Abstract

Summary: 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.