Journal CME November 2025: Risk of septic arthritis after corticosteroid joint injections: A retrospective propensity score-matched cohort analysis-PM R - 2025 - Cooper - Risk of septic arthritis after corticosteroid joint injections A retrospective propensity

PM R - 2025 - Cooper - Risk of septic arthritis after corticosteroid joint injections A retrospective propensity

Pdf Summary

This retrospective cohort study analyzed the risk of septic arthritis (SA) following large joint corticosteroid injections (CSI) using a nationwide U.S. electronic health record database (TriNetX) encompassing 87 million patients from 53 healthcare organizations. SA, a serious joint infection potentially causing joint destruction and mortality, is a rare but feared complication of CSI, common for arthritis management.<br /><br />Researchers identified patients with arthritis diagnoses and compared two cohorts: those receiving large joint CSI during an ambulatory visit and those without such injections. Propensity score matching (1:1 ratio, n=231,544 per group) balanced demographics, comorbidities (e.g., diabetes, cardiovascular, respiratory diseases), and risk factors to minimize confounding. The primary outcome was SA diagnosis within 21 days post-CSI.<br /><br />Results showed an absolute SA risk of 0.0018 (18 per 10,000) among 1,402,959 patients receiving large joint CSI. In the matched cohorts, the SA risk was 0.0010 (10 per 10,000) with CSI versus 0.0017 (17 per 10,000) without CSI, yielding a risk difference of -0.0007 (95% CI, -0.0009 to -0.0005; p < .001). This indicates that CSI does not increase SA risk compared to similar arthritis patients not receiving injections.<br /><br />The study highlights that current standard practices, including sterile techniques and patient selection, likely mitigate SA risk after CSI. Notably, the absolute risk observed here is higher than in some prior single-center or less representative studies, possibly due to the large, diverse cohort and strict methodology. Limitations include reliance on administrative codes without clinical details, inability to specify the injected joint, and potential unmeasured confounders affecting clinician decision-making.<br /><br />In conclusion, CSI for large joints carries a very low absolute risk of SA that is not increased compared to matched controls without CSI. These findings support the safety of CSI under current clinical protocols and assist clinicians in patient counseling regarding infection risks associated with joint corticosteroid injections.

Keywords

septic arthritis

large joint corticosteroid injections

retrospective cohort study

TriNetX database

arthritis management

propensity score matching

infection risk

joint corticosteroid safety

clinical protocols

electronic health records