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

C. Zeng, Nancy E Lane, D. J. Hunter, J. Wei, H. K. Choi, T. E. McAlindon, H. Li, N. Lu, G. Lei, Y. Zhang

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
JournalOsteoarthritis and Cartilage
DOIs
StatePublished - Jan 1 2019

Fingerprint

Knee Osteoarthritis
Osteoarthritis
Adrenal Cortex Hormones
Joints
Knee
Knee prostheses
Hazards
Confidence Intervals
Propensity Score
Replacement Arthroplasties
Cartilage
Structural Models

Keywords

  • Cohort
  • Corticosteroids
  • Osteoarthritis
  • Progression

ASJC Scopus subject areas

  • Rheumatology
  • Biomedical Engineering
  • Orthopedics and Sports Medicine

Cite this

Intra-articular corticosteroids and the risk of knee osteoarthritis progression : results from the Osteoarthritis Initiative. / Zeng, C.; Lane, Nancy E; Hunter, D. J.; Wei, J.; Choi, H. K.; McAlindon, T. E.; Li, H.; Lu, N.; Lei, G.; Zhang, Y.

In: Osteoarthritis and Cartilage, 01.01.2019.

Research output: Contribution to journalArticle

Zeng, C. ; Lane, Nancy E ; Hunter, D. J. ; Wei, J. ; Choi, H. K. ; McAlindon, T. E. ; Li, H. ; Lu, N. ; Lei, G. ; Zhang, Y. / Intra-articular corticosteroids and the risk of knee osteoarthritis progression : results from the Osteoarthritis Initiative. In: Osteoarthritis and Cartilage. 2019.
@article{bf5de0f3ab6c4a61b4a20492dde31abf,
title = "Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative",
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",
author = "C. Zeng and Lane, {Nancy E} and Hunter, {D. J.} and J. Wei and Choi, {H. K.} and McAlindon, {T. E.} and H. Li and N. Lu and G. Lei and Y. Zhang",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.joca.2019.01.007",
language = "English (US)",
journal = "Osteoarthritis and Cartilage",
issn = "1063-4584",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Intra-articular corticosteroids and the risk of knee osteoarthritis progression

T2 - results from the Osteoarthritis Initiative

AU - Zeng, C.

AU - Lane, Nancy E

AU - Hunter, D. J.

AU - Wei, J.

AU - Choi, H. K.

AU - McAlindon, T. E.

AU - Li, H.

AU - Lu, N.

AU - Lei, G.

AU - Zhang, Y.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cohort

KW - Corticosteroids

KW - Osteoarthritis

KW - Progression

UR - http://www.scopus.com/inward/record.url?scp=85061342452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061342452&partnerID=8YFLogxK

U2 - 10.1016/j.joca.2019.01.007

DO - 10.1016/j.joca.2019.01.007

M3 - Article

C2 - 30703543

AN - SCOPUS:85061342452

JO - Osteoarthritis and Cartilage

JF - Osteoarthritis and Cartilage

SN - 1063-4584

ER -