Low-Protein Diet highly beneficial in Dialysis Patients, reports study

Researchers have found in a new study that long-term adherence to a low-protein diet may help preserve residual kidney function in dialysis patients. Additionally, this dietary approach has been linked to increased serum albumin levels, reduced serum phosphorus, and improved nutritional status and electrolyte balance.

A low-protein diet is essential for the nutritional management of chronic kidney diseases as it can reduce renal burden. However, the effect of low-protein diets on dialysis patients compared to pre-dialysis patients remains unclear. This study aims to compare residual renal function among dialysis patients following a low-protein diet versus a normal diet, offering valuable insights into the optimal nutritional strategy for preserving residual renal function. This meta-analysis has been registered on PROSPERO, an international registry of prospective systematic reviews. We conducted a comprehensive and systematic literature search using PubMed, Cochrane Library and Web of Science (WOS). Our search strategy was designed to discover all relevant studies investigating the influence of low-protein diets on residual renal function among dialysis patients. Four studies met the inclusion criteria. Heterogeneity was discussed through subgroup analysis of dialysis method, the addition of ketoacid and other relevant factors. Results: They included four prospective studies of low-protein diets among dialysis patients, each of which included at least 40 participants. Individuals receiving a 12-months low-protein diet had a higher GFR (MD = 1.37 ml/min; 95% CI:0.18 to 2.55), while daily urine volume decreasing more slowly (MD = 660 ml; 95% CI: 110 to 1210). In addition, dialysis patients undergoing a low-protein diet for 4 or 12 months had reduced serum phosphorus (MD=-0.74 g/dl; 95% CI: -1.04 to -0.45). Their serum albumin was higher than dialysis patients received a free-choice diet (MD = 4.00 g/dl; 95% CI: 2.46 to 5.54). Dialysis patients who adhere to a long-term low-protein diet may have a positive effect on residual kidney function. In addition, dialysis patients receiving a low-protein diet increased serum albumin, reduced serum phosphorus levels, and maintained a better nutritional status and electrolyte balance.

Reference:

Xie, J., Liu, X., Ling, Y. et al. The impact of low-protein diet on residual renal function in dialysis patients: a systematic review and metaanalysis. BMC Nephrol 26, 122 (2025). https://doi.org/10.1186/s12882-025-04042-1

Keywords:

Low-Protein, Diet, highly, beneficial, Dialysis, Patients, reports, study, BMC Nephrology, Xie, J., Liu, X., Ling, Y, Low-protein diet, Renal function, Hemodialysis, Peritoneal dialysis, Nutrition

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No link observed between hormone therapy and glioma risk in postmenopausal women: Study

A new study published in the journal of Menopause found that overall, among menopausal women, the usage and duration of hormone treatment did not correlate with glioma risk.

Hormones are important during fetal brain development, act as a neuroprotectant through pathways independent of estrogen receptors in brain degeneration, and may lessen the severity of impairment and mortality risk in traumatic brain injury patients. Reports of a persistent overabundance of gliomas in men, hormone receptors in glial tumors, and variations in incidence rates around ages at menarche and menopause are among the data from human research that seem to imply a hormonal effect on gliomas.

In the Nordic nations, the most common adult malignant brain tumors are gliomas, a diverse group of tumors. Other than ionizing radiation and a few uncommon hereditary disorders, the genesis of gliomas is mostly unclear. Given that the incidence of glioma is around 50% lower in women, it has been proposed that female sex hormones may have a preventive effect. Adult gliomas are the most prevalent primary brain tumors, and there is ongoing debate on the potential contribution of hormone treatment (HT) to their development.

Thereby, to examine the relationship between hormone medication usage and glioma risk, Jinyu Pan and colleagues used data from the Prostate, Colorectal, Lung, and Ovarian Cancer Screening Trial in their cohort design analysis.

A total of 75,335 women between the ages of 50 and 78 who were enrolled between 1993 and 2001 had their data examined for this study. 11.82 years was the median follow-up duration. Hazard ratios (HRs) and 95% CIs for the association between HT usage and glioma risk were estimated using Cox proportional hazard models, which controlled for a number of possible confounders.

Gliomas were detected in 101 subjects throughout the follow-up period. HT usage and glioma risk did not significantly correlate after controlling for pertinent factors. Likewise, no noteworthy correlations were discovered while taking into account HT status or usage duration.

Only the group with at least a college degree showed a significant positive correlation, according to subgroup analysis by marital status, education, oral contraceptive, body mass index, ovariectomy, hysterectomy, ever been pregnant, age at menarche, and age at menopause. There was no significant interaction impact for education. Overall, these findings show that there is no general correlation between HT consumption and the development of gliomas.

Reference:

Pan, J., Shao, C., Xu, C., Zhang, G., Jiang, H., Tang, T., Tang, H., & Wu, N. (2025). Association between hormone therapy and glioma risk in US women: a cancer screening trial. Menopause (New York, N.Y.). https://doi.org/10.1097/GME.0000000000002507

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Microplastics Increase Cancer Risk and Lung Damage in Asthma and COPD Patients: Study Finds

Poland: A recent simulation study published in Scientific Reports revealed that individuals with asthma and chronic obstructive pulmonary disease (COPD) are more susceptible to epithelial cell alterations triggered by microplastic exposure than healthy individuals. Researchers emphasized that inhaled microplastic fibers can induce oxidative stress, local lung injury, and cytotoxicity, though data on their effects on obstructive lung diseases remain limited.

The researchers note that microplastics, formed by the breakdown of plastics due to environmental factors, are found in air, water, and food. Airborne microplastic fibers from textiles, tires, and industrial sources can be inhaled and accumulate in the lungs. Their small size makes them difficult to clear, leading to oxidative stress, inflammation, and potential lung injury. These particles also act as carriers for pollutants, increasing health risks, particularly for individuals with respiratory conditions.

Inhaled microplastic particles can accumulate in the lungs, potentially triggering immune reactions and damaging airway tissues. Magdalena Paplińska-Goryca, Medical University of Warsaw, Banacha 1a, Warsaw, Poland, and colleagues examined how polyamide fibers affect nasal epithelial cells co-cultivated with macrophages in individuals with asthma, COPD, and healthy controls.

For this purpose, the researchers identified 10 adults aged 18 years or older with asthma, eight adults aged 40 years or older with COPD, and 11 healthy controls. Participants with severe asthma or COPD, unstable or uncontrolled conditions, malignancies, or other chronic or acute lung diseases were excluded. Nasal epithelial cells were collected from all participants and exposed to laboratory-generated microplastic fibers for analysis.

Key Findings:

  • Asthmatic and COPD airway epithelial cells exhibited a distinct response to microplastic fiber stimulation compared to healthy epithelial cells.
  • The most notable effects were linked to Th2 inflammation, modulation of stress response, and carcinogenesis.
  • There were no significant differences in cytotoxicity or minor inflammatory effects between patients with asthma or COPD and healthy controls.
  • Flow cytometric analysis revealed a higher presence of CD24+ epithelial cells in asthma patients after exposure to microplastics compared to controls.

The researchers highlighted that several gene candidates identified through RNA-Seq analysis were associated with cancer, as they are upregulated in various cancer types according to existing literature. They further noted that the activation of CD24 on primarily ciliated asthmatic epithelial cells following microplastic stimulation reinforced this link.

However, they acknowledged certain limitations in the study. Using nasal epithelial cells instead of bronchial cells may have restricted the depth of findings. Additionally, patients with severe asthma and COPD were excluded to avoid potential biases caused by oral steroids and antibiotic use, which could influence epithelial cell immunology.

“Despite these limitations, the results indicate that the structural impairment of the airway epithelium in obstructive lung diseases amplifies the impact of microplastic particles compared to a healthy epithelium,” the researchers concluded.

Reference:

Wróbel, M., Adamska, D., Rachowka, J., Królikowska, M., Goryca, K., & Krenke, R. (2025). The impaired response of nasal epithelial cells to microplastic stimulation in asthma and COPD. Scientific Reports, 15(1), 1-18. https://doi.org/10.1038/s41598-025-87242-x

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Extracorporeal Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest: Study Unravels Characteristics and Outcomes

Recent study explored the outcomes of extracorporeal cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and perioperative cardiac arrest. It involved a retrospective review of perioperative extracorporeal CPR in adults. Out of 33 patients, 73% experienced cardiac arrest in the cardiac catheterization laboratory. The survival rate to discharge was 57.6%, with 89.5% having neurologically favorable outcomes. Factors associated with higher survival included shorter CPR time, lower lactate levels, and higher pH levels. The use of extracorporeal CPR in perioperative cardiac arrest demonstrated excellent survival rates with neurologically favorable outcomes in selected patients.

Comparison of Extracorporeal CPR with Conventional CPR

Compared to conventional CPR, extracorporeal CPR showed better potential survival outcomes for in-hospital cardiac arrest. Extracorporeal CPR in perioperative cardiac arrest had higher survival rates compared to in-hospital cardiac arrest. Important observations included the location of extracorporeal CPR events, with most occurring in the cardiac catheterization laboratory, potentially due to advanced monitoring and immediate interventions. Survival was not significantly influenced by the initial pulseless rhythm.

Factors Affecting Survival and Complications Post-Extracorporeal CPR

The study highlighted the importance of factors like lactate and pH levels in predicting outcomes, with lower lactate and higher pH levels associated with increased survival. Patient characteristics, such as ASA Physical Status and the presence of an anesthesia provider, also impacted survival rates. Complications like renal dysfunction, cardiovascular issues, and bleeding were common post-extracorporeal CPR, but did not significantly differ between survivors and nonsurvivors.

Potential of Extracorporeal CPR as a Rescue Therapy in Perioperative Cardiac Arrest

The research emphasized the potential of extracorporeal CPR as a rescue therapy in perioperative cardiac arrest cases, with higher survival rates compared to in-hospital cardiac arrest cases. Selection criteria, including clinical context, duration of CPR, and comorbidities, were discussed as crucial for identifying suitable candidates. The study noted the need for future research to optimize patient selection and timing of extracorporeal CPR initiation in perioperative settings.

Key Points

– Extracorporeal CPR demonstrated favorable outcomes in perioperative and in-hospital cardiac arrest cases, with a survival rate to discharge of 57.6% and 89.5% having neurologically favorable outcomes.

– Factors associated with higher survival included shorter CPR time, lower lactate levels, and higher pH levels in patients who underwent extracorporeal CPR.

– Extracorporeal CPR had better survival outcomes compared to conventional CPR in the setting of in-hospital cardiac arrest, with extracorporeal CPR in perioperative settings showing even higher survival rates.

– The location of extracorporeal CPR events, notably in the cardiac catheterization laboratory, potentially contributed to better outcomes due to advanced monitoring and immediate interventions.

– Factors like lactate and pH levels were significant predictors of outcomes post-extracorporeal CPR, with lower lactate and higher pH levels associated with increased survival.

– Extracorporeal CPR was highlighted as a potential rescue therapy in perioperative cardiac arrest cases, with discussion on the importance of selection criteria, patient characteristics, and identifying suitable candidates for optimized outcomes.

Reference –

Ashie Kapoor et al. (2024). Perioperative Extracorporeal Cardiopulmonary Resuscitation In Adults: A Single-Center Retrospective Review And Analysis.. *Anesthesiology*. https://doi.org/10.1097/ALN.0000000000005312.

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Ultra-low dose CT aids pneumonia diagnosis in immunocompromised patients, reports research

Denoised ultra-low dose CT can effectively diagnose pneumonia in immunocompromised patients using only 2% of the radiation dose of standard CT, according to a study published today in Radiology: Cardiothoracic Imaging, a journal of the Radiological Society of North America (RSNA).

“For patients with weakened immune systems, lung infections can be life threatening,” said lead study author Maximiliano Klug, M.D., a radiologist in the division of diagnostic imaging at the Sheba Medical Center in Ramat Gan, Israel. “CT scans are the gold standard for detecting pneumonia, but repeated scans can expose patients to significant radiation.”

While the early diagnosis of lung infections in immunocompromised patients is important, the risks of cumulative radiation dose exposure from frequent CT scans is a concern.

Ultra-low dose CT reduces radiation exposure but can result in poor image quality due to added “noise,” which manifests as a grainy texture throughout the image. This reduction in image quality can affect the accuracy of diagnosis. Therefore, Dr. Klug and colleagues sought to test the denoising capabilities of a deep learning algorithm on ultra-low dose CT scans.

From September 2020 to December 2022, 54 immunocompromised patients with fevers were referred to Dr. Klug’s division to undergo two chest CT scans: a normal dose scan and an ultra-low dose scan. A deep learning algorithm was applied to denoise all 54 of the ultra-low dose CT scans.

Radiologists individually assessed and documented their findings from the normal dose CT, ultra-low dose CT and denoised ultra-low dose CT scans. They were blinded to all patient clinical information.

The deep learning algorithm significantly improved the image quality and clarity of the ultra-low dose CT scans and reduced false positives. Nodules were also more easily identified on the denoised scans.

The average effective radiation dose for ultra-low dose scans was 2% of the average effective radiation dose of the standard CT scans.

“This study paves the way for safer, AI-driven imaging that reduces radiation exposure while preserving diagnostic accuracy,” Dr. Klug said.

The researchers note that deep learning-based denoising on ultra-low dose CT scans can be beneficial in other patient groups, such as young patients.

“This pilot study identified infection with a fraction of the radiation dose,” Dr. Klug said. “This approach could drive larger studies and ultimately reshape clinical guidelines, making denoised ultra-low dose CT the new standard for young immunocompromised patients.”

Reference:

Denoised Ultra-Low-Dose Chest CT to Assess Pneumonia in Individuals Who Are Immunocompromised Individuals, Radiology Cardiothoracic Imaging (2025)

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Blepharitis associated with increased prevalence of lower eyelid ectropion: Study

A recent retrospective study published in the Seminars in Ophthalmology highlighted a notable association between blepharitis and lower eyelid ectropion. The findings analyzed over 35,000 patients from a medical screening center which spanned over 19 years to provide crucial insights for early diagnosis and management of these conditions, especially in older adults.

Blepharitis is an inflammation of the eyelid, affects around 13.2% of adults, while ectropion which is characterized by the outward turning of the lower eyelid, is rarer at just 0.2%. Despite the relatively low prevalence of ectropion, this study emphasized its increased occurrence in patients already diagnosed with blepharitis.

Of the 35,670 patients included in the analysis, 69 were diagnosed with ectropion, while 4,725 were diagnosed with blepharitis. The outcomes found that the prevalence of ectropion was significantly higher (0.8%) among patients with blepharitis when compared to just 0.1% in the group without.

The study also highlighted important demographic patterns. Both conditions were more common in men (88.4% for ectropion and 85% for blepharitis), with age being a critical factor. Ectropion patients had a mean age of 77.3 years and were much older than the average (52.2 years) of general screened population. Also, blepharitis patients had a mean age of 60.5 years.

The co-occurrence of these conditions, particularly in older male patients, offered vital clues for clinical decision-making. Physicians may need to consider early surgical intervention for ectropion in patients with persistent blepharitis to prevent complications such as ocular surface exposure, chronic inflammation, and excessive tearing (epiphora).

In addition, recognizing blepharitis as a precursor or contributing factor to ectropion illuminates the importance of managing eyelid inflammation through medical treatments. Early intervention for blepharitis may help reduce the progression to ectropion and its associated complications. Overall, this extensive study brings out the intricate relationship between blepharitis and ectropion by reinforcing the need for a proactive approach in managing both conditions.

Source:

Smadar, L., Kapelushnik, N., Ben-Simon, G. J., Segev, S., Soudry, S., Abd-Elkader, A., & Landau Prat, D. (2025). The association between blepharitis and lower eyelid ectropion in a large cohort of patients. Seminars in Ophthalmology, 1–5. https://doi.org/10.1080/08820538.2025.2459311

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Levothyroxine usage for hypothyroidism in pregnancy not linked to elevated prematurity risk: Study

A new study published in BMC Medicine found that levothyroxine supplementation during late pregnancy in individuals with hypothyroidism does not significantly alter the risk of prematurity. Hypothyroidism in pregnancy is known to be associated with obstetrical and fetal complications, including preterm birth. However, whether levothyroxine therapy influences the risk of premature delivery has remained uncertain. This study was conducted by Maya L. and fellow researchers.

The Quebec Pregnancy Cohort was used to conduct a cohort study comparing data for hypothyroid pregnancies from January 1, 1998, through December 31, 2015. The principal analysis determined levothyroxine exposure by presence or absence, total duration, mean daily dose, and cumulative dose during the two months before delivery (preterm gestations) or prior to 37 weeks of gestation (term gestations).

Levothyroxine dosage was contrasted prior to and after the initiation of the second trimester, grouping pregnancies into rising or stable dosage categories. A second method viewed levothyroxine as a time-varying daily exposure from gestational week 14 through delivery or 37 weeks, whichever occurred first. Prematurity was defined as delivery before 37 weeks of gestation, and term pregnancies were censored at this time point because they were no longer at risk of preterm delivery. Statistical models were performed using generalized estimating equations and Cox proportional hazard models with adjustment for potential confounders.

Key Findings

  • 9,489 hypothyroid pregnancies were included in the analysis.

  • Of these, 6,667 (70.3%) participants were exposed to levothyroxine during the two months prior to delivery.

  • Adjusted analysis demonstrated no considerable correlation of levothyroxine exposure with the risk of prematurity (aRR, 0.98; 95% CI, 0.81–1.20).

  • No substantial difference in risk of prematurity was observed according to levothyroxine duration (>30 days: aRR, 0.99; 95% CI, 0.81–1.21), cumulative dose (>7,125 mcg: aRR, 0.97; 95% CI, 0.73–1.27), or mean daily dose (>125 mcg/day: aRR, 0.95; 95% CI, 0.72–1.26).

  • No greater or lesser risk of prematurity was identified between groups with increased or stable dosing (aRR, 0.84; 95% CI, 0.67–1.05).

  • Time-varying exposure analysis replicated no statistically significant relationship between use of levothyroxine and prematurity risk (aHR, 0.95; 95% CI, 0.81–1.11).

The study authors concluded that levothyroxine supplementation in pregnancy among patients with hypothyroidism was not linked to lower prematurity risk. These results add to clinical practice guidelines by affirming that levothyroxine is safe to administer during pregnancy and does not have to be discontinued just to avert preterm birth.

Reference:

Laham M, Sheehy O, Bérard A. Association between levothyroxine supplementation for hypothyroidism in late pregnancy and risk of prematurity: a population-based cohort study. BMC Med. 2025 Feb 21;23(1):105. doi: 10.1186/s12916-025-03934-1. PMID: 39985026; PMCID: PMC11846315.

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Smoking Worsens Survival Rates in Upper Tract Urothelial Carcinoma Patients, suggests study

A recent study revealed a direct correlation between cumulative smoking exposure (CSE) and poorer oncologic outcomes in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The findings from a comprehensive review of 1,041 patients across 17 medical institutions, brought out the detrimental impact of smoking on both cancer-specific survival (CSS) and overall survival (OS).

The study included a total patient pool of 1,730 but focused on the patients with complete pathological and smoking history, categorized smoking exposure into 3 levels as light, moderate, and heavy, based on the number of cigarettes smoked per day and the duration of smoking. Light smoking exposure was defined as a median of 2.0 pack-years, moderate exposure as 13.0 pack-years, and heavy exposure as 40.0 pack-years.

The data showed that the greater the smoking exposure, the worse the survival outcomes. The patients who had never smoked demonstrated the highest 5-year cancer-specific survival (CSS) at 97% and an overall survival (OS) rate of 91%. When compared, Light smokers (2.0 pack-years) had a 5-year CSS of 96% and OS of 89%, Moderate smokers (13.0 pack-years) faced these figures drop to 85% for CSS and 66% for OS and Heavy smokers (40.0 pack-years) had the poorest outcomes, with a 5-year CSS of 75% and OS of 60%.

The research used advanced statistical models to confirm the association between smoking exposure and decreased survival. Both moderate and heavy smoking exposure were independently linked to worse outcomes, even after adjusting for other potential confounding factors. The study found that smoking cessation did not significantly improve survival rates in patients with moderate or heavy smoking exposure. This suggests that after a certain threshold of cumulative smoking, the damage to overall and cancer-specific survival may be irreversible.

This study emphasized the importance of early smoking cessation to prevent the long-term oncologic consequences seen in UTUC patients. Given the aggressive nature of UTUC and the clear link between smoking and worse health outcomes, these outcomes reinforce the need for both preventive measures and continued, aggressive cancer management. Overall, this study highlights that while quitting smoking is beneficial, the earlier patients stop, the better their long-term cancer outcomes. 

Reference:

Bhanvadia, R., Bochner, E., Popokh, B., Taylor, J., Franco, A., Wu, Z., Antonelli, A., Ditonno, F., Abdollah, F., Simone, G., Tuderti, G., Correa, A., Ferro, M., Tozzi, M., Porpiglia, F., Tufano, A., Perdonà, S., Broenimann, S., Singla, N., … Margulis, V. (2025). Cumulative smoking exposure impacts oncologic outcomes of upper tract urothelial carcinoma. Urologic Oncology. https://doi.org/10.1016/j.urolonc.2025.01.018

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Vaginal dysbiosis increases risk of endometrial polyp recurrence after hysteroscopic polypectomy: Study

Preoperative vaginal dysbiosis has been identified as an independent risk factor for the recurrence of endometrial polyps (Eps) following hysteroscopic polypectomy, according to the recent study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

The excessive amount of estrogen is linked to the production of Eps. Eps has also been linked to other risk factors, including as age, obesity, hypertension, and tamoxifen usage. Eps can cause infertility and irregular uterine bleeding, although it is unknown if untreated Eps can develop into a cancer. However, for big and symptomatic polyps, hysteroscopic surgery is advised.

Intervention on microbiota composition is important and promising in the treatment of gynecological disease because vaginal microbiota dysbiosis, which is defined by a rise in microbial variety and a loss of Lactobacillus dominance, is directly linked to gynecological diseases. Caini Wei and colleagues investigated if preoperative vaginal dysbiosis affects endometrial polyp recurrence following hysteroscopic polypectomy.

This observational cohort study comprised a total of 679 patients from the hospital, which is associated with the university. Every patient had a hysteroscopic polypectomy, and transvaginal ultrasonography was used every 6 months to check for the recurrence of endometrial polyps. Preoperative vaginal dysbiosis, polyp size, parity, quantity, existence of uterine fibroids, polycystic ovarian syndrome, endometriosis, and body mass index were among the extensive clinical data gathered. To evaluate the influence of these characteristics, the cohort was divided into recurrence and non-recurrence groups, and comparative analyses were performed.

Endometrial polyp recurrence was substantially correlated with preoperative vaginal dysbiosis and endometriosis (P < 0.05). Preoperative vaginal dysbiosis had an odds ratio (OR) of 3.286 (95% CI: 2.675–3.786), while endometriosis had an OR of 3.328 (95% CI: 2.567–3.643). Subsequent investigation showed that the non-recurrence group had considerably greater bacterial density, bacterial diversity, and the Lactobacillus detection rate than the recurrence group (P < 0.05).

Conversely, the recurrence group had substantially higher levels of Gardnerella vaginalis presence, enhanced leukocyte esterase activity, and Candida detection than the non-recurrence group (P < 0.05). Overall, this study found that preoperative vaginal dysbiosis is a significant risk factor for endometrial polyp recurrence following hysteroscopic polypectomy.

Source:

Wei, C., Ye, L., Tang, S., Chen, P., Huang, J., & Zhi, Z. (2025). The association between preoperative vaginal dysbiosis and endometrial polyp recurrence after hysteroscopic polypectomy: A retrospective-prospective cohort study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 307, 148–153. https://doi.org/10.1016/j.ejogrb.2025.02.002

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Intra-Articular Corticosteroid Injections have long term pain relief benefit among Osteoarthritis patients, claims study

Researchers have found in a new study that intra-articular steroid injections were associated with a reduced need for opioids, both alone and in combination products among osteoarthritis patients. This benefit was observed for injections into the hip, shoulder, hand, and knee. British patients who received these injections showed decreased usage of opioid-containing drugs and other painkillers for years afterwards.

A study was done to estimate the effect of intra-articular corticosteroid injection (IACI) for osteoarthritis on longer-term incidence of pain medications. They conducted a cohort study of patients registered in the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database with an incident diagnosis of knee, hip, hand, or shoulder osteoarthritis between 2005–2019. Exposure of interest was single or repeated use of IACI (analysed separately). Main outcome measures were five-year incidence of uncombined opioids, opioid-nonopioid analgesic combinations, oral corticosteroids, paracetamol, oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and topical NSAIDs. Instrumental Variable (IV) analysis was used given this methodology can account for strong and unmeasured confounding. Secondary analyses used propensity-score matching and Cox regression. Results: Amongst 74 527 knee osteoarthritis patients, IACI use was associated with lower subsequent prescribing of most pain medications studied, including opioid-nonopioid analgesic combinations following single IACI (number needed to treat [NNT]=5 [5–6], p< 0.001) and uncombined opioids following repeat IACI (NNT = 12 [95% CI: 8–546], p= 0.049). Amongst 15 092 hand osteoarthritis patients, single IACI was associated with reduced use of opioid-nonopioid combinations, paracetamol, and oral NSAIDs. Secondary analyses confirmed lower incidence rates of opioid-nonopioid combinations after single IACI for knee (hazard ratio [HR] =0.88 [0.81–0.96]), hip (HR = 0.76 [0.62–0.92]), hand (HR = 0.77 [0.61–0.98]), or shoulder (HR = 0.72 [0.53–0.99]) osteoarthritis. IACI for knee or hand osteoarthritis showed lower incidence of several pain medications over the longer-term relative to no IACI use. Secondary findings suggest IACI may be effective in reducing longer-term use of opioid-nonopioid analgesic combinations for patients with knee, hip, hand, or shoulder osteoarthritis.

Reference:

Samuel Hawley, Albert Prats-Uribe, Gulraj S Matharu, Antonella Delmestri, Daniel Prieto-Alhambra, Andrew Judge, Michael R Whitehouse, Effect of intra-articular corticosteroid injections for osteoarthritis on the subsequent use of pain medications: a UK CPRD cohort study, Rheumatology, 2025;, keaf126, https://doi.org/10.1093/rheumatology/keaf126

Keywords:

Samuel Hawley, Albert Prats-Uribe, Gulraj S Matharu, Antonella Delmestri, Daniel Prieto-Alhambra, Andrew Judge, Michael R Whitehouse, Osteoarthritis, Steroid Injection, Prescribing, Pain management, Pharmaco-epidemiology

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