Corticosteroids work by suppressing inflammatory signals that are sent by our immune system. This can have a positive and a negative impact on our joints. Inflammation is destructive to tissues in the body, by suppressing inflammation it can save potential damage. The use of these steroids for acute injury and acute inflammation has shown to be effective. In relation to osteoarthritis where inflammation is not acute and it is chronic, the corticosteroid injections can suppress growth of tissues; in the long run this can further increase degeneration and lead to severe damage.
There have been multiple studies looking at the use of corticosteroid injections. Most studies suggest a good short-term benefit generally between 1 to 3 months . One very good study found that regular three-month injections of corticosteroid injections for two years resulted in no significant change in pain and function in comparison with saline. Aside from poor improvements, this study noted a significant adverse effect on the patient’s joints. There were significant losses in cartilage for all patients whom received corticosteroid injections as opposed to saline .
Systematic reviews in literature conclude corticosteroid injections can be effective in controlling pain and improving function on short term . It is of greater benefit for individuals who have acute inflammation as opposed to chronic inflammation. Long term use of these injections should be approached with caution as they can cause more harm than good. They should only be used in cases where it is deemed 100% necessary.
Prolotherapy is not extremely common; it involves injection of a mild irritant solution directly on the site of the arthritis or injury. This can create a mild, controlled injury that stimulates the body’s natural healing mechanisms to lay down new tissue on the weakened areas.
Many studies have been evaluated and results are in agreeance. Prolotherapy has shown improvement for pain, function and range of motion of the joint. This is applicable in short and long term .
Systematic reviews reveal Prolotherapy is useful for mild to moderate osteoarthritis and tendinopathy (tendonitis). The mechanism of repair is not well understood at this stage and literature assumes there is a systemic multifactorial effect that takes place. However, evidence suggests Prolotherapy is safe in treating symptomatic low grade osteoarthritis in carefully selected patients , .
Ozone therapy focuses on increasing the amount of oxygen present in our body. In treatment of osteoarthritis it is commonly provided as an injection of ozone directly into the joint.
One randomized, blinded and placebo controlled clinical trial assessed 98 patients with symptomatic knee osteoarthritis. This study revealed ozone was more effective than placebo. Additionally the ozone injections proved to relieve pain, improve function and in-turn increase the patient quality of life .
Another study compared ozone injections with hyaluronic acid in the short-term. There were 3 arms in this study;
- HA injections of 23 patients,
- Ozone injections of 23 patients and
- Combination of both injections 24 patients.
Results of this study concluded a combination of ozone and HA yielded significantly better outcomes .
Plasma injections can go by 2 other main abbreviations, there is the longer version “Platelet Rich Plasma” and in short “PRP injections”. Plasma injections start by harvesting the patient’s blood, then concentrating the plasma that is contained in the blood. From this point, the concentrated plasma will be injected directly into the inflamed or injured area.
The process works by communicating with cytokines (signals) in your body to trigger a concentrated repair process to the area injected. The plasma contains growth factors and nutrients which can speed up repair processes in soft tissues significantly.
Multiple studies have observed PRP injections, one randomised clinical trial observed a total of 50 patients, 28 patients received PRP injections and 22 received saline as the placebo. The PRP group showed significant improvements in their symptoms as compared to the placebo group. No side-effects were observed in either group. The group of patients whom received PRP injections also had shown some cartilage regrowth observed by MRI imaging 6 months post treatment. These patients also presented reduction in joint pain and improvements in their joint function as well as improvements to their overall quality of life .
Furthermore, meta-analysis observing a total of 2328 patients over 17 PRP studies confirmed significant reduction in pain in post PRP injections even after a total joint replacement . The improvements were most pronounced in helping function of the joints via repair to surrounding supporting tissues such as muscles and tendons in the rehabilitation stage .
PRP appears to be a safe and cost effective option to help with managing and repairing early stages of osteoarthritis as well as any soft tissue injuries.
Lubrication / Viscosupplementation Injections
Lubrication injections such as hyaluronic acid, is a gel-like fluid that is injected into the joints of patients with arthritis. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. This acts as a lubricant in order to enable bones to move smoothly without harsh grinding. The gel-like substance also has shown to have shock absorbing properties.
Metal analysis of publications observing 12 randomised controlled trials containing 1794 patients indicate, the injection of HA into a joint provide a decrease in pain and increase in function. In comparison to corticosteroid injections, corticosteroids appear to be superior in controlling pain in the first month post injection. However, the HA injections last much longer than corticosteroids, the effect of HA continues to last from 3 to 6 months post first injection . The immediate short term effects appear to be higher in the group of patients whom have received HA injections, but the long term side effects for corticosteroid injections significantly outweigh the short term side effects presented by hyaluronic acid injections ,.
Overall, the viscosupplementation injections can potentially relieve pain for up to 6 months. This is longer than the pain relief derived from nonsteroidal anti-inflammatory drugs and corticosteroid injections. HA injections administered at the early stages of arthritis may be more beneficial than when given later in the more advanced stages of arthritis . Individuals should consider combining viscosupplementation injections with conventional therapy as it can be more effective than a single pronged approach .
Read about more treatment options for osteoarthritis on this page.
All references can be found in our list of references page here.