SAT295 Metabolic And Endocrine Risks In Association With The Use Of Intraarticular Glucocorticoid Injections: A Retrospective Study
Authors: Rabiei-Flori Elham , Yin Yue , Hasan Farhad 
Published: October 2023

Abstract
Disclosure: E. Rabiei-Flori: None. Y. Yin: None. F. Hasan: None.
Introduction: The use of intraarticular glucocorticoid injections (IGCI) to alleviate chronic pain from degenerative joint disease (DJD) is very common and the frequency of their use is probably underestimated. In our clinical experience the harmful metabolic effects of the frequent IGCI use are concerning, yet are not well studied. It is well-known that chronic exposure to systemic glucocorticoids is the most common cause of Cushing’s syndrome; i.e., iatrogenic Cushing’s (IC). There are, however, limited data assessing the link between IGCI use and IC. Methods: In this retrospective study we compare the outcomes in two large populations, both of which had received intraarticular injections to alleviate DJD pain. The first population received IGCI, while the second (comparison) population received a non-steroid, hyaluronic acid injection (IAHA). We hypothesize that, compared to the use of IAHA, the use of IGCI is associated with worse metabolic and endocrine outcomes, such as higher frequencies of diabetes, insulin requirement, obesity, hypertension, osteoporosis, and vertebral compression fractures. We included patients aged 18-90 years who received ≥1 IAHA dose versus ≥ 5 IGCI to a major joint (hip, knee, or shoulder) between 1/1/2017-9/30/2021. Results: During the study period 34,600 subjects received at least one of the two treatments (30,273 received IGCI vs 4327 who received IAHA; ratio of IGCI to IAHA population ≈ 7). Among the IGCI population 2421 (8%) received ≥ 5 IGCI injections. Comparisons are provided for this subset vs. IAHA. At baseline, mean age in the IGCI vs IAHA groups were 66.3 (±11.5) and 63.8 (±11.8) years, respectively. The use of IGCI was 2 folds higher and the use of IAHA was 1.5 folds higher in females than males. Most patients were White (88.6% and 90% in the IGCI and IAHA groups, respectively). There was no difference in BMI between the groups at baseline (both 32.7 ± 7). Compared to the IAHA population, those who received ≥ 5 IGCI had significantly higher frequency of incident diabetes (42.1% vs. 35.3%, p 0.0006), requiring insulin therapy for diabetes (14.8% vs 12.6%, p=0.02), hypertension (55.4% vs. 43.6%, p &lt;0.001), osteopenia (7.9% vs 5.7%, p=0.001), osteoporosis (8.8% vs 4.9%, p&lt;0.0001), vertebral compression fracture (2.1% vs. 1.3%, p=0.04), depression (14.3% vs. 9.5%, p&lt;0.001), cataract (3.6% vs. 2 %, p=0.0008), emergency room visit (48.8% vs 43.2%, p &lt; 0.0001), ER visit for hypertension (3.4% vs 2.3%, p=0.02) and hospitalization for any reason (32.6% vs 27%, p&lt;0.0001). Furthermore, the IGCI population had significantly lower lumbar spine BMD on DXA scan (0.98 vs 1.04 g/cm3, p=0.02). In contrast, the prevalence of obesity or severe obesity was not different between the two populations. Conclusion: compared to IAHA, the use of IGCI is associated with increased frequency of endocrine and metabolic risks that are observed in iatrogenic Cushing’s syndrome.
Presentation: Saturday, June 17, 2023