Knee osteoarthritis: weak evidence supports corticosteroid injections

Access to the full content of this site is available only to registered healthcare professionals. Register to read more


  • Although evidence is of low quality, steroid injections for osteoarthritis may be associated with moderate improvements in function and pain with decreasing benefits with time elapsed from injection, and no evidence for benefit after 6 wk.

Why this matters

  • Steroid injections are a common treatment for osteoarthritis, but have significant side effects, especially with repeated use.

Study design

  • Synopsis of a recently updated Cochrane meta-analysis of 27 studies by the same authors of steroid injections compared with either sham injection or no intervention in patients with knee osteoarthritis (KOA), with discussion of role of corticosteroids in treatment.

Key results

  • The authors estimated that 1 additional patient with KOA treated with corticosteroid would benefit for every 8 patients treated.
  • The authors say their conclusions are consistent with guidelines by the American Academy of Orthopaedic Surgeons 2013, noting poor evidence precluding recommendation; with conditional recommendation for steroid injection by the American College of Rheumatology; and with recommendation for adjunct consideration by the Institute for Health and Care Excellence.


  • Low-quality evidence.
  • Significant heterogeneity among studies.
  • Associations of treatment with benefit were lower when studies with industry funding and insufficient concealment of allocation were left out of the analysis.