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

Zeng C, Lane NE, Hunter DJ, et al. · Osteoarthritis and Cartilage

Corticosteroid initiation was associated with a 3-fold hazard of radiographic KL-grade worsening (HR 3.02) and continuous use with 4.7-fold (HR 4.67); joint-space-narrowing hazards were similarly elevated.

Population

684 propensity-matched OAI participants (148 corticosteroid initiators, 536 comparators), 48-month follow-up

Intervention

Intra-articular corticosteroid use (initiation and continuous use)

Comparator

Non-users (propensity-score matched, marginal structural models)

Limitations

Observational — confounding by indication (worse knees get injected) survives matching imperfectly; corroborates rather than proves the RCT harm signal.