Do Cortisone Injections Treat Knee Osteoarthritis?

A recent clinical trial conducted in China has revealed that injecting glucocorticoids (cortisone) into the infrapatellar fat pad provides no significant benefit in alleviating knee pain or reducing inflammation associated with osteoarthritis, compared to saline injections, over a 12-week follow-up period, according to a report on the scientific website MedicalXpress.

According to the study published in JAMA Network Open, this type of injection, which was proposed as a potential therapeutic option to directly target inflammatory foci, did not demonstrate statistically significant superiority over placebo, despite the widespread use of intra-articular cortisone injections as a means of pain relief.

Osteoarthritis is one of the most prevalent chronic diseases globally, affecting approximately 595 million people, with knee joints being the most commonly affected area.

This disease is associated with reduced mobility, decreased quality of life, and higher mortality rates among the elderly, particularly in the absence of curative treatments, especially given rising obesity rates and an aging population.

It is well known that some cases of knee osteoarthritis are accompanied by inflammation involving adjacent tissues, such as the joint synovium and the infrapatellar fat pad, which play a significant role in sustaining inflammation.

Furthermore, joint effusion, along with synovial hypertrophy—a condition known as synovitis—occurs in more than 46 percent of patients and is associated with increased pain severity, accelerated cartilage damage, and a higher likelihood of undergoing joint replacement surgery.

The study involved 60 patients across four Chinese medical centers who participated in a randomized, double-blind trial. Some patients received ultrasound-guided cortisone injections into the infrapatellar fat pad, while others received saline injections, with regular follow-ups over 12 weeks.

The results showed that pain intensity gradually decreased in both groups, but the difference between them was not statistically significant. No significant differences were recorded in synovial inflammation size measured by MRI, nor in quality-of-life indicators or the need for pain medication. Conversely, a slight improvement in cartilage damage indicators was observed in the cortisone group, although this did not translate into clinical symptom relief.

Researchers concluded that cortisone injections into the infrapatellar fat pad do not provide noticeable improvements in pain or inflammation in the short term, emphasizing the need for longer-term studies to evaluate long-term structural effects, such as fat atrophy or cartilage loss.

These findings highlight the necessity of reevaluating some common treatment practices and seeking more effective and safer strategies to address the growing global burden of knee osteoarthritis.