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

C. Zeng, N. 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 journalArticlepeer-review

69 Scopus citations


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
StatePublished - Jan 1 2019


  • Cohort
  • Corticosteroids
  • Osteoarthritis
  • Progression

ASJC Scopus subject areas

  • Rheumatology
  • Biomedical Engineering
  • Orthopedics and Sports Medicine


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