It’s a common scenario. If you have chronic knee pain but want to avoid the cost and risk of knee surgery, you have periodic injections of corticosteroids. However, a recent study published in the May 16 issue of the Journal of the American Medical Association (JAMA) found that such injections can increase cartilage loss of the course of two years with minimal clinical benefit.

The study was a randomized controlled trial in which researchers compared outcomes between two groups of 70 patients. The average age was 58, and with symptomatic knee osteoarthritis identified through ultrasounds. The subjects underwent MRIs at the beginning and end of the study to see the effects on cartilage. Those who received the injections lost about two times as much cartilage as those in the placebo category (the latter received only saline injections).

Many physicians criticized the study and its findings. One physician commented that the measurable loss of cartilage over a 20 year period would be minimal (the thickness of a fingernail) and should not be a basis for discontinuing such injections. “If the knee is already badly damaged and the patient is not ready or safe for a total knee replacement there is a role for quarterly steroid injections.” Another physician wrote that he has given such injections for more than 20 years, and has thousands of patients who have had great improvement in their symptoms and ability to function.

The study was of quarterly injections given over two years, and one physician commented that this frequency of steroid injections exceeded the guidelines. “If I give you enough of anything it will make it appear dangerous. What’s next? Water can kill you, news at 11.” But yet another physician commented that steroid injections only provide temporary relief, and should not be given unless one wants to pay the price with cartilage damage over decades. He noted that veterinarians know that these injections should be avoided by anyone who wants to preserve their animal rather than replace them.