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wonder
why? a scientific editorial
The Deterioration of Articular Cartilage in Osteoarthritis
by Corticosteroid Injections
Ross A. Hauser, MD
The hallmark feature of osteoarthritis is the breakdown in the articular cartilage
of joints such as the knee and hip. Both animal and human research has consistently
shown that corticosteroid injections into normal and degenerated knees accelerate
the arthritic process. A summary of the effects of the intraarticular corticosteroids
on articular cartilage includes: a decrease of protein and matrix synthesis,
matrix hyaline appearance becomes fibrotic, clumping of collagen, alteration
in chondrocyte cell shape, chondrocyte cell proliferation inhibited, chondrocyte
cytoxicity enhanced, loss of chondrocytes, surface deterioration including edema,
pitting, shredding, ulceration and erosions, inhibition of articular cartilage
metabolism, articular cartilage necrosis, thinning of articular cartilage, decrease
in cartilage growth and repair, formation of articular cartilage cysts, and ultimately
articular cartilage destruction.
When researchers microscopically and radiologically examine human joints after
corticosteroid injections, the same results are found in humans as in animals.
Intraarticular corticosteroid injections accelerate the osteoarthritic degenerative
process. Because of this possibility, organizations such as the American College
of Rheumatology acknowledge, “It is generally recommended, although not well
supported by published data, that injection of corticosteroids in a given joint
not be performed more than three to four times in a given year because of concern
about the possible development of progressive cartilage damage through repeated
injection in the weight-bearing joints.” It is this author’s opinion that there
is no doubt that the rise of osteoarthritis, as well as the number of hip and
knee replacements, is a direct result of the injection of corticosteroids into
these joints.
Journal of Prolotherapy. 2009;2:107-123.
KEYWORDS: articular cartilage, corticosteroid injections, degeneration, osteoarthritis,
Prolotherapy, regeneration. |
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