Steroid injections for OA knee

[chriss48]

Hi, I'm 74 had PMR since 2017, lowest dose Ive been at is 4.5 mgs, currently at 7.5mgs. Been involved with local MSK service since August 2022 following injury left knee, diagnosed as oa with possible damage to cartilage. Physio not helped, steroid injection a possibility but according to MSK protocol I have to be at 4mgs or under of Prednisolone to be allowed an injection. Has anyone else experienced similar.

[DorsetLady PMRGCAuk volunteer]

Hi,

It certainly wasn't my GP's protocol (not sure about MSK wasn't under them at that time) when I had a couple for my knee.. one in Aug 2014 when at 8mg, second in May 2015 at 5mg and third in Sept 2015 at 3.5mg.

But it was GP, and a few years ago... but don't really follow the logic...

[jinasc]

drugs.com/answers/you-corti...

Can you get a cortisone shot while taking oral prednisone? Take a look at this link and then check with your Pharmacist and ask the question.

Methinks they got it a bit wrong................

[PMRpro Ambassador]

May be their protocol but there is absolutely NO reason why you can't have a steroid shot in a joint while taking oral pred. Usually it would be done to avoid raising the oral dose.

[chriss48 in reply to PMRpro]

Thanks for all your helpful comments/info, all very interesting. I've actually had the knee problem since August 2021 (not 2022), it's just about worn me down. Im going to go back to MSK and query their rationale, wish me luck.

[PMRpro Ambassador in reply to chriss48]

The only thing I can think of that they can use to justify it is that pred does increase the risk of infections. But loads of PMR patients have had steroid injections - so shopping around might help.

[chriss48 in reply to PMRpro]

Thanks, where can I shop around though? Go to GP maybe, or see someone privately, not sure what my options are

[PMRpro Ambassador in reply to chriss48]

Definitely worth starting with the GP - there may be one who does injections at the practice.

[DorsetLady PMRGCAuk volunteer in reply to chriss48]

Most GP surgeries have a least one GP who will/can do it.

[Sukydee]

I saw my Rheumatologist at the end of October, when I was on 10mg Pred and he has referred me for knee injection which is due on 21st December. There was no hesitation on his part.

[chriss48 in reply to Sukydee]

Well thanks for this, I'm certainly going to seek clarification from MSK, good luck with your injection, hope it goes well.

[PMRpro Ambassador in reply to chriss48]

Hope they are better than the guy I saw - he informed me that if I could touch my toes (actually I could get my hands on the floor) I couldn't have a back problem! Wrong! He'd obviously never heard of hypermobility syndrome which brings its own problems ...

[Exflex]

I’ve had the steroid injections in the knee whilst on higher doses of oral Pred (can’t remember the exact dose, but 8mg possibly). NHS guidance was to have just one knee done due to Covid. I’ve not had a repeat injection for 12+ months, finding exercise a better solution.

[jules1955]

Hi there, I had injection in left knee last week and going for right one this week and I'm on 5mg and that is with my GP and she gives injection. Dosage didn't appear to be an issue.

Jules x

[DakotaMae]

Hi chriss48, I can’t speak to your direct question but a recent study suggests steroid injections caused overall progression of osteoarthritis in the knee. I believe the study was based on a two-year period. Alternatively, according to the study, “Compared to the control group, the group who received hyaluronic injections showed a decreased progression of osteoarthritis, specifically in bone marrow lesions.“

May be worth asking:

medicalxpress.com/news/2022...

[SusanEleven in reply to DakotaMae]

I’ve seen other studies out there on Hyaluronic acid injections. I can try to search them out again but if I’m remembering correctly they didn’t perform higher than placebo. And yes, there is info on steroid injections causing rapid OA progression in a small subset of patients, plus other potential issues.

This is the 2019 article in a radiology journal that discusses it. I’m bringing it to orthopedics for my consult about a guided injection for my very unhappy hip.

Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? | Radiology

pubs.rsna.org/doi/10.1148/r...

If you don’t want to slog through the whole thing here is the conclusion:

”In conclusion, intra-articular corticosteroid (IACS) injections are frequently performed with the hope of relieving joint pain. However, large retrospective analyses and prospective studies evaluating accelerated osteoarthritis (OA) or joint destruction after IACS injections are lacking. We believe that certain patient characteristics, including but not limited to acute change in pain not explained by using radiography and no or only mild OA at radiography, should lead to careful reconsideration of a planned IACS injection. In these circumstances, MRI may be helpful to further evaluate the actual cause of pain prior to a planned injection. Given that IACS injections are increasingly performed to treat pain in patients with hip or knee OA, we suggest that the radiologic community should actively engage in high-quality research on this topic to better understand potential at-risk conditions prior to intervention and to better understand potential adverse joint events after these procedures to avoid possible complications.”

[chriss48 in reply to SusanEleven]

Thanks very much for providing this interesting and thought provoking information. I do have some reservations about having an injection as not convinced symptoms are wholly down to oa. I have thought about MRI and am thinking of seeking a private medical opinion from someone who can look at the whole picture. It feels piecemeal at present and getting to see GP at my surgery is still difficult.

[SusanEleven in reply to chriss48]

I’ve said the same many times. I feel like no one is putting the pieces together. I’m in the US and it took me a year to get a video appointment with my PCP (GP to you). I hope you get some clear answers soon.

A nurse practitioner at an Urgent Care clinic told me last week that US healthcare was in trouble before Covid and now it’s completely broken.

[DakotaMae]

very interesting. My husband is constantly reminding me that we have to be our own advocates we these doctors. It’s exhausting sometimes though with the research. All the best to you. I’m hoping you’ll get relief through one treatment or another.