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Osteoarthritis Cartilage. 2019 Jan 29. pii: S1063-4584(19)30033-0. doi: 10.1016/j.joca.2019.01.007. [Epub ahead of print]

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

Author information

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.

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

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

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