Concerns Over Long-term Steroids and NSAID’s for Joint Pain: Why Prolotherapy and PRP May be Better Long-Term Options

During the recent December 2020 annual American Academy of Orthopedic Medicine (AAOM) conference, concerns were voiced over the use of corticosteroids. For many years, steroids and NSAIDs have been a mainstay in pain management. They remain the “community standard of care”. But for those of us in regenerative joint management, there has been increasing awareness that steroids and long-term NSAID’s (Motrin, Naprosyn, e.g.) can have potentially damaging effects on native tissues.

If you’ve ever been advised against multiple steroid injections/year, you will appreciate the following information. Multiple injections of corticosteroid can actually damage the very cells that provide support to the joint and joint surfaces. Studies have shown damaging effects that these medicines can have on cells that produce cartilage, as well as cells that repair tendon and ligament structures.

Intra-articular (IA) corticosteroid therapy has been used for the treatment of inflammation and pain in the knee, for example, since the 1950’s. Corticosteroid therapy has been shown to be effective at temporarily alleviating joint symptoms associated with osteoarthritis and other inflammatory disorders. However, the long-term negative effects of these medications on articular cartilage remains a concern. The deleterious effects of the reviewed corticosteroids on articular cartilage are extensively supported by the basic science literature. The beneficial effects of corticosteroids occurred at low doses and short durations (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. However, at higher doses and longer durations (>3 mg/dose or 18-24 mg/cumulative total dose in vivo), corticosteroids were associated with gross cartilage damage and chondrotoxicity. The literature demonstrates the complex effect methylpredisolone, dexamethasone, betamethasone, and hydrocortisone have on cartilage proteins through the processes of protein production and breakdown. Methylprednisolone, dexamethasone, and hydrocortisone have demonstrated simultaneous mediation of both beneficial and detrimental upstream regulators of cartilage protein synthesis and breakdown.

Many in the field of regenerative joint therapy (prolotherapy) as a result, have promoted injection solutions designed to heal native tissues, regenerating the very structures injured from trauma or as a result of joint instability.

For more on this topic, I invite you to watch a recent interview with Dr. Ross Hauser, MD at Caring Medical in Ft. Meyers, Florida, who expands on this topic.