Rapid Progressive Arthritis After Steroid Injection and AVN Treatment

Amie defines rapidly progressive idiopathic arthritis as losing 2 mm or 50% of joint space within a year, which can follow an intra-articular steroid injection because of chondrocyte toxicity. In a study of 1,471 injected patients, narrower joint space on x-ray, not gender, BMI, diabetes, osteoporosis or dose, predicted it, so she is more cautious about injecting advanced osteoarthritis. In the first case, a 76-year-old caregiver on prednisolone used a shared decision making tool and chose a private injection. Weeks later she needed a walking frame, and same-day x-rays showed femoral head collapse with a subcapital fracture, leading to emergency hip replacement. In the second, a 45-year-old man drinking 92 units a week felt better because he had modified his activity, yet his x-ray reported as normal showed early AVN. Amie discussed him with orthopedics, requested an MRI, advised avoiding impact and safety netted him. Treatment options include bisphosphonates, regenerative medicine, rotational osteotomy, core decompression and vascular bypass, though most of her patients reach hip replacement. Her key messages are layered clinical reasoning and MRI when the x-ray is normal.