Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Apr 27;3(5):2325967115581163.
doi: 10.1177/2325967115581163. eCollection 2015 May.

The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review

Chloe Wernecke  1 , Hillary J Braun  1 , Jason L Dragoo  1
Affiliations
Review

The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review

Chloe Wernecke et al. Orthop J Sports Med. .

Abstract

Background: Intra-articular (IA) corticosteroid therapy has been used for the treatment of inflammation and pain in the knee since the 1950s.

Purpose: To review the current literature on the effects of IA corticosteroids on articular cartilage.

Study design: Systematic review.

Methods: A MEDLINE and SCOPUS database search was performed, and studies were selected for basic science and clinical trial research on corticosteroids with direct outcome measures of cartilage health. Preliminary searches yielded 1929 articles, and final analysis includes 40 studies.

Results: Methylprednisolone, dexamethasone, hydrocortisone, betamethasone, prednisolone, and triamcinolone were reported to display dose-dependent deleterious effects on cartilage morphology, histology, and viability in both in vitro and in vivo models. The beneficial animal in vivo effects of methylprednisolone, hydrocortisone, and triamcinolone occurred at low doses (usually <2-3 mg/dose or 8-12 mg/cumulative total dose in vivo), at which increased cell growth and recovery from damage was observed; the single human clinical trial indicated a beneficial effect of triamcinolone. However, at higher doses (>3 mg/dose or 18-24 mg/cumulative total dose in vivo), corticosteroids were associated with significant gross cartilage damage and chondrocyte toxicity. Dose and time dependency of corticosteroid chondrotoxicity was supported in the in vitro results, however, without clear dose thresholds.

Conclusion: Corticosteroids have a time- and dose-dependent effect on articular cartilage, with beneficial effects occurring at low doses and durations and detrimental effects at high doses and durations. Clinically, beneficial effects are supported for IA administration, but the lowest efficacious dose should be used.

Keywords: articular cartilage; betamethasone; chondrocytes; corticosteroid; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; triamcinolone.

PubMed Disclaimer

Conflict of interest statement

The authors reported that they have no conflicts of interest in the authorship and publication of this contribution.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
See this image and copyright information in PMC

References

    1. Albano MB, Skroch GP, Ioshii SO, Grahels XS, de Alencar PG, Matias JE. Computerized photocolorimetric analysis of the effects of intraarticular betamethasone on the proteoglycan concentration of leporine knee cartilage matrix: influence of the number of intraarticular injections. Rev Col Bras Cir. 2009;36:256–260. - PubMed
    1. Badurski JE, Schwamm W, Popko J, Zimnoch L, Rogowski F, Pawlica J. Chondroprotective action of salmon calcitonin in experimental arthropathies. Calcif Tissue Int. 1991;49:27–34. - PubMed
    1. Barker WD, Martinek J. An ultrastructural evaluation of the effect of hydrocortisone on rabbit cartilage. Clin Orthop Relat Res. 1976;(115):286–290. - PubMed
    1. Behrens F, Shepard N, Mitchell N. Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids. J Bone Joint Surg Am. 1975;57:70–76. - PubMed
    1. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005328. - PubMed