Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Health Evidence, Nijmegen, the Netherlands.
Bone Joint J. 2020 May;102-B(5):586-592. doi: 10.1302/0301-620X.102B5.BJJ-2019-1376.R1.
Recent studies have suggested that corticosteroid injections into the knee may harm the joint resulting in cartilage loss and possibly accelerating the progression of osteoarthritis (OA). The aim of this study was to assess whether patients with, or at risk of developing, symptomatic osteoarthritis of the knee who receive intra-articular corticosteroid injections have an increased risk of requiring arthroplasty.
We used data from the Osteoarthritis Initiative (OAI), a multicentre observational cohort study that followed 4,796 patients with, or at risk of developing, osteoarthritis of the knee on an annual basis with follow-up available up to nine years. Increased risk for symptomatic OA was defined as frequent knee symptoms (pain, aching, or stiffness) without radiological evidence of OA and two or more risk factors, while OA was defined by the presence of both femoral osteophytes and frequent symptoms in one or both knees. Missing data were imputed with multiple imputations using chained equations. Time-dependent propensity score matching was performed to match patients at the time of receving their first injection with controls. The effect of corticosteroid injections on the rate of subsequent (total and partial) knee arthroplasty was estimated using Cox proportional-hazards survival analyses.
After removing patients lost to follow-up, 3,822 patients remained in the study. A total of 249 (31.3%) of the 796 patients who received corticosteroid injections, and 152 (5.0%) of the 3,026 who did not, had knee arthroplasty. In the matched cohort, Cox proportional-hazards regression resulted in a hazard ratio of 1.57 (95% confidence interval (CI) 1.37 to 1.81; p < 0.001) and each injection increased the absolute risk of arthroplasty by 9.4% at nine years' follow-up compared with those who did not receive injections.
Corticosteroid injections seem to be associated with an increased risk of knee arthroplasty in patients with, or at risk of developing, symptomatic OA of the knee. These findings suggest that a conservative approach regarding the treatment of these patients with corticosteroid injections should be recommended. Cite this article: 2020;102-B(5):586-592.
最近的研究表明，膝关节内皮质类固醇注射可能会损害关节，导致软骨丢失，并可能加速骨关节炎（OA）的进展。本研究旨在评估膝关节有症状的 OA 患者或有发展为膝关节有症状的 OA 风险的患者接受关节内皮质类固醇注射是否会增加接受关节置换术的风险。
我们使用了 Osteoarthritis Initiative（OAI）的数据，这是一项多中心观察性队列研究，每年对 4796 名膝关节有症状或有发展为膝关节 OA 风险的患者进行随访，随访时间长达九年。有症状的 OA 风险增加的定义为频繁的膝关节症状（疼痛、酸痛或僵硬）而没有 OA 的放射学证据，且存在两个或更多的危险因素，而 OA 则定义为存在股骨骨赘和一个或两个膝关节的频繁症状。使用链式方程进行了多次插补以填补缺失数据。采用时间依赖性倾向评分匹配，在接受第一次注射时对患者进行匹配。使用 Cox 比例风险生存分析估计皮质类固醇注射对随后（全部和部分）膝关节置换术的发生率的影响。
在剔除随访丢失的患者后，共有 3822 名患者进入研究。在接受皮质类固醇注射的 796 名患者中，共有 249 名（31.3%），在未接受皮质类固醇注射的 3026 名患者中，有 152 名（5.0%）接受了膝关节置换术。在匹配队列中，Cox 比例风险回归得到的风险比为 1.57（95%置信区间 1.37 至 1.81；p < 0.001），与未接受注射的患者相比，每次注射会使膝关节置换术的绝对风险在 9 年的随访中增加 9.4%。
皮质类固醇注射似乎与膝关节有症状的 OA 患者或有发展为膝关节有症状的 OA 风险的患者的膝关节置换术风险增加有关。这些发现表明，对于这些接受皮质类固醇注射治疗的患者，应推荐采用保守治疗方法。
