Osteoarthritis and the role of corticosteroid injections: The four groups

Background: Corticosteroid injections are commonly used in the treatment of pain in osteoarthritis. A question that is frequently asked is ‘how many corticosteroid injections can be used’ and the answers given appear to be empirical. Aim: To determine how many corticosteroid injections should be used in osteoarthritis. Methods: PubMed was used to identify articles using terms appropriate to each heading. We reviewed the clinical course of osteoarthritis with evidence from studies of pain and function, radiology, inflammation, and biomechanics. We reviewed possible pain mechanisms and the evidence for the effects and side effects of corticosteroid injections. The conclusions were drawn from an evaluation of the information presented. Results: The reviews led to a classification of osteoarthritis into four groups: improvement, slow/non-progression (the largest group), rapid progression, and chronic pain, and to an evidence-based recommendation for use of corticosteroid injections in each of the four groups. Conclusion: Corticosteroids should be used in conjunction with the evidence-based recommendations for education, weight loss, and exercise. None are recommended where there is improvement with simple interventions alone, one or two in patients with slow/non-progression, none to one in patients with rapid progression, and in chronic pain two or three a year along with other chronic pain management interventions.