Corticosteroid injections

Corticosteroids are powerful anti-inflammatory medicines. Doctors prescribe corticosteroids for people with arthritis who need quick relief from severe inflammation. The American College of Rheumatology (ACR) recommends corticosteroid injections as an alternate initial therapy for patients who have moderate to severe knee pain and signs of inflammation who do not feel better taking acetaminophen. You can have corticosteroid injections in the same joint three to four times per year.

Hyaluronic acid therapy

Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant. However, the acid appears to break down in people with osteoarthritis. Injecting hyaluronic acid (Synvisc, Hyalgan) into a joint may lessen pain and inflammation. According to ACR guidelines, hyaluronic acid therapy may help patients with knee OA who do not feel better using NSAIDs, or who have had adverse side effects from these drugs.

On The Horizon

There are no medications yet to treat the underlying disease process of OA. But scientists are making headway in the pursuit of therapies that may do just that.  Rather than making osteoarthritis a little easier to live with, future therapies for OA could potentially slow, stop or even repair joint damage. “I am quite encouraged by what the pipeline looks like in OA,” says Jasvinder Singh, MD, an associate professor of medicine at the University of Alabama at Birmingham School of Medicine who has conducted studies of patients with various forms of arthritis, including OA.

Here are four potential OA treatments that our experts say are worth watching:

  • Canakinumab - Canakinumab is a monoclonal antibody designed to block interleukin-1 beta (IL-1b), which has been linked to cartilage breakdown in osteoarthritis. It is already approved for systemic juvenile arthritis and other diseases. Doctors are also studying it as a gout treatment. Studies have shown that single intraarticular injections of the drug are well tolerated in people with osteoarthritis of the knee.
  • Bone morphogenetic protein-7 (BMP-7, OP-1) is a protein that naturally stimulates bone growth. Preclinical data suggest that it can block the effects of the IL-1b, preventing the breaking down of cartilage. Animal studies have shown it can prevent or reverse damage in OA.  A 2010 study published in the Journal of Orthopaedic Research found that weekly injections of BMP-7 prevented existing cartilage damage from getting worse in rabbits.
  • PH-797804 – This experimental anti-inflammatory medicine taken by mouth blocks proteins that are involved in the signaling pathways related to joint tissue destruction. A phase II clinical trial is attempting to evaluate how well the drug works with patients who have knee OA flares.
  • FGF-18 is a growth factor that has shown promise in stimulating new cartilage cells in OA. Researchers are conducting clinical trials of the drug given by intraarticular injection to patients with primary knee osteoarthritis who are candidates for total knee replacement.

Medications not working? Find out when to consider joint replacement surgery.