Steroid Injections vs. Hyaluronic Acid Injections for Osteoarthritis: Comparing Treatments

For many people, chronic knee pain isn't just uncomfortable, it can affect their ability to perform even the simplest tasks and hinder their favorite activities. Fortunately, osteoarthritis knee treatments are available for short-term and long-term relief. Two common treatments include steroids and viscosupplementation (hyaluronic acid). Here, the team at Reflex Knee Specialists compares these two options and discusses their differences, side effects, and more.

About Osteoarthritis of the Knee

Osteoarthritis (OA) of the knee is a chronic and progressive degenerative joint disease. Commonly occurring in prior athletes and patients over the age of 40, this condition occurs when chronic inflammation in the knee joint gradually wears away cartilage tissue, causing friction between the bones. Additionally, the quality of synovial fluid, a gel-like substance that lubricates the joint, is reduced significantly, further compounding joint dysfunction. OA can include the following symptoms:

• Stiffness, especially first thing in the morning and after sitting for long periods
• Pain with activities such as stairs or squatting
• Joint feeling like it is "locking" or "sticking" during movement
• Swelling
• Sensation of Knee instability

Along with lifestyle changes to help protect the joint and slow the progression of arthritis, a provider may recommend over-the-counter (OTC) pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs) to help relieve the symptoms. However, dosage increases and prolonged use can lead to certain health risks, like gastrointestinal ulcers, high blood pressure, kidney damage, and similar concerns.

Because of the risks and the mixed results from OTC medications, providers often recommend knee injections – either steroids or hyaluronic acid – to provide relief.

How Do Steroid Injections and Hyaluronic Acid Treatments Differ?

Steroid and hyaluronic acid injections are both administered directly into the joint itself and each treatment yields different results.

Steroid Injection for Arthritis

Steroid injections are ideal for treating OA flare-ups, such as the pain and swelling that come with fluid building up the knee. This treatment often works quickly, but its effects may only last for a few weeks.  Additionally, repeated treatments with steroids is damaging to cartilage tissue.

Hyaluronic Acid Injection for Arthritis

Also known as hyaluronan, hyaluronic acid is found within the synovial fluid. This naturally occurring substance aids in healthy knee functionality, promoting flexibility and mobility. Injecting a concentrated form of hyaluronan into the joint can help in the following ways:

• Decreases inflammation of the knee
• Enables more comfortable levels of activity
• Improves cartilage health
• Potentially preserves existing knee cartilage

Is One Treatment More Effective Than the Other?

Steroid injections reduce inflammation within the joint and typically provide some relief within 24 to 48 hours. However, they tend to produce less effective results after the initial treatment. In many cases, physicians recommend these shots only a few times per year since frequent usage can damage the cells in the knee that produce cartilage.

Hyaluronic acid (HA) injections also help relieve pain and inflammation. But because this substance cushions and lubricates the joint, these injections tend to yield more long-term benefits. Additionally, instead of damaging cartilage, HA treatments provide a cushioning and protective effect. Depending on the severity of inflammation and damage inside the joint, patients may experience positive results that last anywhere from three to six months.

What Are the Side Effects of Steroid Knee Injections?

Like many medications, steroid knee injections are primarily effective short term and come with a risk of adverse reactions. Common side effects of steroidal knee injections include the following:

• Cortisone flare: This symptom occurs when a corticosteroid crystallizes in the joint, briefly causing more pain than what a patient had experienced previously.

• Cartilage Damage: repeated steroid treatments damage cartilage cells

• Weakened ligaments and tendons: This side effect may contribute to increased knee degradation over time.

What Are the Side Effects of Hyaluronic Acid Knee Injections?

Approved by the Food and Drug Administration (FDA) for osteoarthritis in 1997, hyaluronic acid (HA) knee treatments can be repeated without adverse side effects. In fact, most patients who are treated with this type of joint fluid therapy experience a cumulative effect: they experience greater symptom relief after each series of HA treatment. HA also boosts the body's natural production of hyaluronan, which improves the joint environment for the cartilage.  HA also reduces pain and inflammation which can augment the overall quality of life for a patient.

What Are the Efficacies of Each Knee Treatment?

Hyaluronic acid (HA) injections are a safe and effective approach to osteoarthritis of the knee over extended periods. Not only do these treatments alleviate pain and stiffness, they also prolong the life of the joint and allow some patients to postpone or avoid joint replacement surgery. In studies that compare cortisone with hyaluronic acid, researchers have found that patients who receive corticosteroid knee injections experience an increase in OA progression compared to participants who received HA treatments.

 Graphic represents results from Cortisone Injection in knee.

Book a Consultation for Joint Fluid Therapy Today

Patients with knee osteoarthritis can schedule a comprehensive evaluation with the highly experienced team at Reflex Knee Specialists for safe and effective symptom relief. Serving patients in Portland, Oregon; Bellevue, Washington; and Tempe, Arizona, our providers offer non-surgical treatments for an array of knee conditions to help alleviate chronic pain and preserve joint health. Contact us today to learn more about hyaluronic acid (HA) treatments and how they can help relieve pain.