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Tag Archives: injections
Corticosteroid injections associated with progression of knee osteoarthritis
Two studies comparing injections commonly used to relieve the pain of knee osteoarthritis found that corticosteroid injections were associated with the progression of the disease. Results of both studies were presented today at the annual meeting of the Radiological Society of North America (RSNA).
Osteoarthritis is the most common form of arthritis, affecting 32.5 million adults in the U.S. Knee osteoarthritis is a chronic, degenerative and progressive condition with an estimated incidence of 800,000 patients each year. More than 10% of patients with knee osteoarthritis seek noninvasive treatment for pain relief through corticosteroid or hyaluronic acid injections.
Researchers in both studies chose cohorts from the Osteoarthritis Initiative, a multicenter, longitudinal, observational study of nearly 5,000 participants with knee osteoarthritis currently in its 14th year of follow-up.
In the first study, researchers at the University of California, San Francisco included 210 Osteoarthritis Initiative participants, 70 of whom received intraarticular injections, and a control group of 140 who did not receive injections during a two-year period. Of the 70 patients who received injections, 44 were injected with corticosteroids, and 26 were injected with hyaluronic acid. The treatment and control groups were matched by age, sex, body mass index, pain and physical activity scores, and severity of disease.
MRI was performed on all patients at the time of the injection and two years before and after. The MRI scans were assessed using whole-organ magnetic resonance imaging score (WORMS), a grading system for knee osteoarthritis that focuses on the meniscus, bone marrow lesions, cartilage, joint effusion and ligaments. The researchers identified osteoarthritis progression by comparing the imaging scores from the initial scans and two-year follow-up scans.
This is the first direct comparison of corticosteroid and hyaluronic acid injections using the semi-quantitative, whole organ assessment of the knee with MRI.”
Upasana Upadhyay Bharadwaj, M.D., Research Fellow, Department of Radiology, University of California, San Francisco
Statistical analysis showed that corticosteroid knee injections were significantly associated with the overall progression of osteoarthritis in the knee, specifically in the lateral meniscus, lateral cartilage and medial cartilage.
Hyaluronic acid knee injections were not significantly associated with the progression of osteoarthritis in the knee. Compared to the control group, the group who received hyaluronic injections showed a decreased progression of osteoarthritis, specifically in bone marrow lesions.
“While both corticosteroid and hyaluronic acid injections are reported to help with symptomatic pain relief for knee osteoarthritis, our results conclusively show that corticosteroids are associated with significant progression of knee osteoarthritis up to two years post-injection and must be administered with caution,” Dr. Upadhyay Bharadwaj said. “Hyaluronic acid, on the other hand, may slow down progression of knee osteoarthritis and alleviate long term effects while offering symptomatic relief.”
In the second study, researchers at the Chicago Medical School of Rosalind Franklin University of Medicine and Science conducted a case-control study comparing the radiographic progression of osteoarthritis in patients who received injections of corticosteroids and hyaluronic acid.
“While these injections provide some patients with short-term pain relief, the effects of the injections on the progression of the disease are unknown,” said researcher and medical student Azad Darbandi.
Darbandi’s team selected a cohort of 150 patients with similar baseline characteristics from the Osteoarthritis Initiative database, including 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who were not injected over a 36-month time period. The groups were matched by sex, body mass index and X-ray findings.
Patients underwent X-ray imaging of the knee at baseline and two years later. The researchers analyzed the X-ray imaging, including joint space narrowing, formation of bone spurs, and bone thickening around the knee cartilage.
Compared to patients who received an injection of hyaluronic acid or no treatment at all, patients injected with corticosteroids had significantly more osteoarthritis progression, including medial joint space narrowing, a hallmark of the disease.
“Even though imaging findings for all patients were similar at baseline, the imaging hallmarks of osteoarthritis were worse two years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all,” Darbandi said. “The results suggest that hyaluronic acid injections should be further explored for the management of knee osteoarthritis symptoms, and that steroid injections should be utilized with more caution.”
“Knowing the long-term effects of these injections will help osteoarthritis patients and clinicians make more informed decisions for managing the disease and the pain it causes,” Dr. Upadhyay Bharadwaj added.
Dr. Upadhyay Bharadwaj’s co-authors are Thomas Link, M.D., Ph.D., Zehra Akkaya, Gabby Joseph, John Lynch, Ph.D., and Paula Giesler. Darbandi’s co-authors are Sean Hormozian, Atefe Pooyan, M.D., Ehsan Alipour, M.D., Firoozeh Shomal Zadeh, M.D., Parham Pezeshk, M.D., and Majid Chalian, M.D.
Source:
Radiological Society of North America
Steroid injections may make arthritis WORSE, studies show
Steroid injections used to treat arthritis in the knee may actually make the condition worse, two studies suggest.
Researchers from the University of California, San Francisco (UCSF) and Chicago Medical School gathered data from hundreds of osteoarthritis patients to gauge how their condition would react to the shots.
Between both studies, 94 patients who received corticosteroids — anti-inflammatory drugs used to treat a variety of medical conditions — saw their condition deteriorate.
Those who received hyaluronic acid injections, a naturally produced substance that lubricates the joints, saw the progress of their condition slow.
Previous research suggests corticosteroids may damage cartilage in a joint and make it more susceptible to wearing down, leaving patients needing hip or knee replacements.
More than 32.5million adults in the US have knee arthritis, with approximately 80 per cent of adults over 55 years old having evidence of the condition.
More than one in ten of these patients opt to get corticosteroid or hyaluronic acid injections to relieve their pain.
The above shows the knee joint of a patient with arthritis (left), with the arrows indicating where cartilage has been worn away. The other (right) shows a patient who does not have arthritis
In the first study — to be presented Monday at the Radiological Society of North America — researchers in California analyzed two years of data for 210 patients with osteoarthritis in the knees.
More than half the group — 140 people — did not get the injections during this time.
Among the rest, 44 were injected with corticosteroids, while 26 were injected with hyaluronic acid.
Corticosteroids reduce the activity of white blood cells and stop the immune system from causing the painful inflammation.
Hyaluronic acid is naturally found in the fluid of a person’s eyes and joints.
It acts as lubrication for the joints, helping mitigate pain when they are used.
All were matched by age, sex, body mass index, pain and physical activity scores and severity of disease.
MRIs were done two years before treatment, at the time of treatment and two years later, with scans scored for arthritis progression.
Analysis showed those who got corticosteroid injections had significantly faster arthritis progression compared to the other groups.
The hyaluronic acid treatment group, however, showed a decreased progression of osteoarthritis compared to those who got no treatment.
Dr Upasana Upadhyay Bharadwaj, a radiologist at UCSF who led the study, said: ‘While both corticosteroid and hyaluronic acid injections are reported to help with symptomatic pain relief for knee osteoarthritis, our results conclusively show that corticosteroids are associated with significant progression of knee osteoarthritis up to two years post-injection and must be administered with caution.
‘Hyaluronic acid, on the other hand, may slow down progression of knee osteoarthritis and alleviate long term effects while offering symptomatic relief.’
He added that this was the first study directly comparing the two treatments using these types of MRI scans.
In the second study from researchers in Chicago, data was analyzed on 150 patients who were monitored for a 36-month period.
The group was evenly split between people who got no injections, hyaluronic injections and corticosteroid injections. They were also matched by sex, body mass index and X-ray findings.
Patients underwent an X-ray when injections were administered and two years later, with each scored for progression of the disease.
Those who got the corticosteroid injections had significantly more osteoporosis progression two years later, results showed.
But those who got hyaluronic acid injections or no treatment at all did not have as rapid deterioration.
Azard Darbandi, a medical student at Chicago who led the research, said: ‘The imaging hallmarks of osteoarthritis were worse two years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all.
‘The results suggest that hyaluronic acid injections should be further explored for the management of knee osteoarthritis symptoms, and that steroid injections should be utilized with more caution.’
Patients may opt to get corticosteroid injections in the knee to provide short-term pain relief against arthritis.
But over the longer term these studies suggest that they can actually lead to more rapid deterioration in the joints, prompting more pain.
Participants were recruited from the Osteoarthritis Initiative which is an observational study of nearly 5,000 patients. It is now in its 14th year.
Scientists create insulin tablet that can be taken orally, replacing injections
Scientists create insulin tablet that can be taken orally, replacing injections diabetics must currently give themselves multiple times a day
- A team at the University of British Columbia has developed an insulin pill that is just as effective as injections of the hormone
- The pill can successfully deliver the dosage to the liver instead of losing some as it travels through the stomach
- First trials were conducted on rats, and found great success in getting insulin to the liver
- More than 10% of Americans suffer from diabetes, and the condition kills around 100,000 people in the U.S. each year
A research team has developed an oral tablet that can deliver insulin to the body without the use of needles.
Scientists at the University of British Columbia (UBC), in Canada, have developed a pill that delivers an entire dosage of insulin to a person’s liver. Previous attempts at oral insulin medication have been foiled after large portions of the doses ended up in the stomach – where it provides no value.
Many diabetics require several doses of insulin to manage their condition daily. Currently, the standard delivery method is via injections with small needles multiple times a day. This can be especially uncomfortable, unwieldy and is harder than just taking a pill.
The Centers for Disease Control and Prevention reports that 37 million Americans – or more than one-in-ten – suffer from diabetes. It is the eighth leading cause of death in America, responsible for just over 100,00 fatalities each year.
A team at UBC has developed a pill that can deliver dosages of insulin orally that a diabetic would often need to inject themselves to receive (file photo)
‘These exciting results show that we are on the right track in developing an insulin formulation that will no longer need to be injected before every meal, improving the quality of life, as well as mental health, of more than nine million type 1 diabetics around the world,’ Dr Anubhav Pratap-Singh, an assistant professor in food processing at UBC and principal investigator of the study said in a statement.
The researchers developed a pull that uses a thin membrane called the buccal mucosa that is found in the inner cheek lining and in the back of a person’s lips.
This membrane provides a protective lining around the dosage and allows it to pass through to its destination without losing medicine along the way.
Insulin is naturally produced in the pancreas, then travels to the liver where it helps process blood sugar.
A person suffering from type 1 diabetes does not produce enough insulin to manage blood sugar – if at all. All type 1 diabetics require some sort of insulin dosage to manage their condition.
Those with type 2 diabetes may also need insulin medication, a the amount of the substance their body naturally produces may not be enough to deal with their elevated blood sugar.
The standard injection of insulin in 100 international units (iu) per shot.
Because a vast majority of it is lost during oral delivery, previous attempts to develop an insulin pill have had to carry around 500iu to properly function.
This is extremely inefficient and could needlessly drive up the cost of pills – especially with how controversially expensive insulin has become in countries like the United States.
There is also the issue of how fast the serum is released. Injections are fast acting and quickly provide the body with the boost in insulin it needs.
Tablets can often take two to four hours to deliver the dosage. The pill developed by the UBC team is fully released within 30 minutes to two hours.
Insulin injections are used by many type 1 diabetics, and even some type 2 diabetics, to boost levels of the hormone and manage their blood sugar
‘Similar to the rapid-acting insulin injection, our oral delivery tablet absorbs after half an hour and can last for about two to four hours long,’ Dr Alberto Baldelli, a senior fellow who took part in the research, said.
Researchers tested their newly developed pill on rats in attempt to see how they would flow through the body. Results of the trials were promising.
‘Even after two hours of delivery, we did not find any insulin in the stomachs of the rats we tested,’ Yigong Guo, first author of the study and PhD candidate at UBC, said.
‘It was all in the liver and this is the ideal target for insulin—it’s really what we wanted to see.’
The American Diabetes Association says that the current crop of available diabetes pills are only to be used in additional insulin injections, for people who need additional help managing their condition.
These pills are also only recommended for type 2 diabetics to use, with no option for those suffering from type 1.
The UBC team is hoping its new invention can help close that gap for those whose pancreas does not produce enough insulin, and give them an easier option to receive dosages.
Botox injections may reduce anxiety, study says
Botox injections can reduce anxiety by up to 72 per cent, surprise findings from a new study reveal.
Scientists in California have found reductions in anxiety symptoms for people receiving Botox, regardless of where it was injected.
Botox, or Botulinum toxin, a medication derived from a bacterial toxin, is injected to ease wrinkles, migraines, muscle spasms, excessive sweating and incontinence.
It’s not clear how exactly it reduces symptoms of anxiety, although researchers speculate botulinum toxins may be transported to the regions of the central nervous systems involved in mood and emotions.
If Botox is commonly used to treat chronic conditions that may contribute to anxiety – for example, wrinkles – its success in relieving the underlying problem may indirectly also relieve anxiety.
Clinical trials will be necessary to establish the best site and dose to administer Botox specifically for anxiety, according to the study authors.
Botox, or Botulinum toxin, a medication derived from a bacterial toxin, is commonly injected to ease wrinkles, migraines, muscle spasms, excessive sweating and incontinence. Researchers have found it reduces reported anxiety symptoms regardless of injection site
The research was performed by experts at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego, in collaboration with two physicians from Germany.
More than one million Britons get Botox injections every year, and the procedure is even more common in the US.
The potential dangers of Botox, including pain, swelling or bruising at the injection site, headaches, droopy eyelids, drooling and eye dryness – have been well-documented.
‘A large number of diverse adverse effects are being reported to the FDA and the main objective usually is to find those harmful side effects that had not been identified during clinical trials,’ said study author Ruben Abagyan, professor of pharmacy at University of California San Diego.
‘However, our idea was different. Why don’t we do the opposite? Why don’t we find beneficial effects?’
For the study, Abagyan and colleagues studied the US Food and Drug Administration (FDA)’s Adverse Effect Reporting System (FAERS) database.
FAERS contains some 13 million individual reports of negative effects after taking various medications – among them, reports from nearly 40,000 people of what happened to them after Botox treatment, taken for a variety of reasons.
In the UK, the cost of Botox injections can vary from about £100 to £350 for each treatment, depending on the clinic and the area being treated
The team scoured the database for the absence or reduced frequency of anxiety and anxiety-related disorders as a health complaint, compared to a control group, when taking Botox.
Then the team applied a mathematical algorithm to look for statistically significant differences between Botox users and patients who received different treatments for the same conditions.
People receiving Botox injections at four different sites on the body – including the forehead – reported anxiety significantly less often than patients undergoing different treatments for the same conditions, they found.
The reported anxiety risk was 22 to 72 per cent lower in Botox-treated patients for four of eight conditions and injection sites: facial muscles for cosmetic use; facial and head muscles for migraine; upper and lower limbs for spasm and spasticity; and neck muscles for torticollis.
Torticollis, also known as wryneck, is a twisting of the neck that causes the head to rotate and tilt at an odd angle.
For the other four injection sites, there was not enough data for statistically significant confidence intervals, according to Abagyan.
The team said they excluded reports in which a person was also taking antidepressants (often used in treating anxiety) or anxiolytic medications.
However, they admit that the use of other prescription and over-the-counter medications could have been underreported in some cases.
Abagyan and his team published another study last year using the same database that found Botox to be an effective treatment for people with depression.
People who received Botox injections reported depression significantly less often than patients undergoing different treatments for the same conditions.
Both studies found a decrease in reported symptoms regardless of injection site.
So this challenges any speculation that patients may have felt happier just because they have fewer wrinkles, or because Botox prevents frowning.
Although researchers don’t know the specific molecular mechanisms by which Botox reduces depression and anxiety, they might be different between the two conditions.
The new study has been published today in the journal Scientific Reports.
Texas nurse convicted of killing 4 men with air injections
A Texas nurse was convicted Tuesday of capital murder in the deaths of four patients who died after prosecutors say he injected them with air following heart surgeries.
The Smith County jury deliberated for about an hour before finding William George Davis, of Hallsville, guilty of capital murder involving multiple victims. Prosecutors planned to seek the death penalty during the sentencing phase, which was scheduled to start Wednesday.
Davis, 37, was accused of injecting air into the four patients’ arteries after they underwent heart surgery at the Christus Trinity Mother Frances Hospital in Tyler in 2017 and 2018. During recovery from their surgeries, the four — John Lafferty, Ronald Clark, Christopher Greenway, and Joseph Kalina — suffered unexplained neurological problems and died.
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This undated file photo provided by the Smith County Jail shows William George Davis. Davis, a Texas nurse has been convicted of capital murder in the deaths of four patients who died after prosecutors say he injected them with air following heart surgeries. Smith County Jail via AP, File)
During the trial, Dr. William Yarbrough, a Dallas-area pulmonologist and professor of internal medicine, explained to the jury how injecting air into the arterial system of the brain causes brain injury and death.
Yarbrough said he was able to determine there was air in the arterial system of the victims’ brains by viewing images from brain scans — something he said he had never before observed in his decades in medicine.
Christus Trinity Mother Frances Hospital in Tyler, Texas (Google Maps)
He ruled out blood pressure problems or any other causes of death besides the injection of air and said it must have happened after the surgeries because the complications occurred while the patients were in recovery.
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Defense attorney Phillip Hayes told the jury that the hospital had issues and that Davis was a scapegoat who was only charged because he was there when the deaths occurred.
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Prosecutor Chris Gatewood said during closing arguments that Davis “liked to kill people.” And prosecutor Jacob Putman said the hospital hadn’t changed any of its procedures and hadn’t had any similar incidents since Davis left.
UK to ban face injections for teens under the age of 18
Anti-wrinkle and filler injections are being banned for beauty consumers who are under the age of 18 in the U.K.
The age restriction for the two cosmetic procedures reportedly comes at a time when tens of thousands of teens have undergone treatments to smooth or plump their features, according to the Daily Mail and The Sun.
Starting on Oct. 1, it will become illegal for certified injectors to administer cosmetic muscle paralyzers or fillers on patients who are under 18.
Age verification will also become a requirement before treatment to ensure patients and injectors are complying with the legal act.
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Anti-wrinkle and filler injections are being banned for beauty consumers who are under the age of 18 in the U.K.
(iStock)
Exceptions will exist for doctors who may need to use an injectable for a medical reason. For example, some doctors approve the use of botulinum toxin – the key ingredient in Botox – to ease teeth grinding, jaw clenching and chronic migraines.
Most consumers however seek out these treatments for cosmetic purposes rather than medical, which includes lip, cheek, jaw, chin, nose, forehead, under eye and even body enhancement.
Both The Daily Mail and The Sun report 41,000 injectable procedures were administered on patients under the age of 18 in the U.K. last year.
Nadine Dorries – the minister of state at the Department of Health and Social Care – reportedly voiced her support for the regulation in a statement she provided to the Daily Mail.
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“Holding back the years is fine once you get to a certain age. But far too many people have been left emotionally and physically scarred after botched cosmetic procedures,” Dorries wrote to the British news outlet. “So we are continuing to work closely with organizations to assess the need for stronger safeguards around potentially harmful cosmetic procedures.”
In recent years, celebrities and social media influencers have come forward to share the adverse effects they’ve had with cosmetic injectables.
Reality TV star Khloe Kardashian admitted she had a negative reaction to a facial filler during a 2016 episode from her show “Kocktails with Khloe.”
Khloe Kardashian, 37, admitted she had a negative reaction to a facial filler during a 2016 episode from her show “Kocktails with Khloe.”
(Reuters)
“I don’t know if it’s Botox or filler. I did one of them and my whole face went numb and I could not make [an expression]. I had to dissolve everything,” she said at the time. “I looked crazy and I still think the effects are like, in there.”
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Similarly, lifestyle blogger Whitney Buha went viral in March when she showed her followers and the rest of the world that she suffered a severely droopy eyelid after she got Botox injections. She has since recovered from the negative reaction.
Despite some notable figures opening up about the risks that come with injectables, Dorries and other critics believe social media and the rich and famous have contributed to the rising demand for the two non-surgical procedures, especially among teens.
Across the pond, the U.S. Food and Drug Administration approves the use of botulinum toxin for patients who are at least 18 years old and facial fillers for patients who are at least 21 years old.
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The global facial injectable market size was valued at $13.4 billion in 2020, according to market research estimates from Grand View Research. The firm projects the market will continue to grow by a compound annual growth rate of 8.8% from 2021 to 2028.
Dax Shepard testosterone injections and the risks of steroids
Actor Dax Shepard has spent years talking openly about sobriety, building his highly successful Armchair Expert podcast around an ethos of vulnerability. Shepard was in recovery for 16 years when he revealed in September that he had relapsed with prescription pain pills, a fact he was reticent to admit publicly but that he decided was relevant for a fanbase who had come to admire his honesty.
In his latest disclosure, the 46-year-old said on his podcast with guests Ashton Kutcher and Mila Kunis that he is using “heavy testosterone injections.”
“I spent my whole life as a medium boy,” he said after Kutcher remarked on the size of his biceps, “and now I’m a big boy and I like it.”
Shepard initially said he was using testosterone to bulk up, but when Kutcher and Kunis expressed concern, Shepard said low testosterone runs in his family and that using it has also helped improve his disposition.
Testosterone is a hormone that helps men maintain everything from muscle strength to facial hair to sex drive. While there are medical reasons for using testosterone, experts say steroid use carries many physical and mental health risks.
“Testosterone is an androgen. It is a powerful steroid that can have a lot of effects downstream, that can impact mood, that can then impact anxiety, that can also itself lead to addiction,” said Collin Reiff, an addiction psychiatrist at NYU Langone Health who specializes in substance abuse treatment.
Medical uses for testosterone
Testosterone peaks during adolescence and young adulthood, according to the Mayo Clinic, and declines with age. Shalender Bhasin, a professor of medicine at Harvard Medical School, said testosterone is only approved by the U.S. Food and Drug Administration (FDA) for one clinical use: treatment of hypogonadism in men (a condition where the body does not produce enough testosterone).
Testosterone treatment is also medically appropriate, Bhasin said, as gender affirming care.
Dessa Bergen-Cico, coordinator of the Addiction Studies program at Syracuse University, says the use of alcohol, cannabis, amphetamines and opioids, which Shepard said he abused during his last relapse, can all lower testosterone. Opioid agonist therapies, including methadone and suboxone, can also suppress testosterone. In these cases, experts say testosterone replacement therapy may be recommended, but only under the care of a medical professional.
But even when testosterone is prescribed, it can include a host of dangerous and unwelcome side effects, including an increased risk of blood clots and cardiac problems as well as enlarged breasts and limited sperm production.
While Shepard said testosterone has helped with his mood – he said he “was depressed after (the 2017 film) ‘CHIPS'” and now is “on fire to work” – Bhasin said its efficacy in treating major depression has not been shown.
“There is agreement that testosterone does not improve major clinical depression,” he said.
Misuse of testosterone
Endocrinologists say the majority of testosterone misuse is driven by body dissatisfaction. Most people who misuse testosterone are young men, almost always weightlifters and recreational bodybuilders who are using testosterone to look leaner and more muscular.
“It’s a body image disorder,” Bhasin said.
Shepard said he wanted to build muscle mass and has “gained about 24 pounds” by working out “six days a week, lifting heavy (weights),” and using testosterone.
Bergen-Cico said exercise is also viewed in the field of behavioral health as a legitimate addiction, and steroids can exacerbate it.
“The use of steroids can play into that and they can become not addictive in the same way as stimulants and depressants but can play into the same reward and reinforcement pathways in the brain,” she said. “It also fosters an increase in adrenaline, aggression and anger, which can have an addictive quality or bite to it.”
Michael Parent, a psychology professor at the University of Texas at Austin, said the paraphernalia required to administer testosterone may add an additional layer of risk for some people in recovery.
“If someone is using injectable steroids, that means they have needles around and for some people those needles are triggers,” he said. “You might have a stock of hundreds of needles and for some people, it just removes one more barrier from a potential relapse.”
Experts stress that no one should use steroids unless under the care of a medical professional. There are significant long-term risks of steroid use.
“One-third of men who use large doses will have profound suppression of testicular function when they stop,” Bhasin said. “It can take months or years to recover. Some may not.”