Effect of intra-articular corticosteroid injections for osteoarthritis on the subsequent use of pain medications: a UK CPRD cohort study

Journal article

Objectives: To assess the effect of intra-articular corticosteroid injection (IACI) for osteoarthritis on longer-term incidence of pain medications.

Methods: We 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. Main outcome measures were five-year incidence of uncombined opioids, opioidnonopioid analgesic combinations, oral corticosteroids, paracetamol, oral Non-Steroidal AntiInflammatory 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.

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]) and uncombined opioids following repeat IACI use (NNT=12 [95% CI: 8-546]). Amongst 15,092 hand osteoarthritis patients, single IACI was associated with reduced use of opioid-nonopioid combinations (NNT=5 [95% CI: 5 to 9]), 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=0.70 [0.51-0.97]) osteoarthritis.

Conclusions: 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.

Authors: Hawley, S; Prats Uribe, A; Matharu, GS; Delmestri, A; Prieto Alhambra, D

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: Rheumatology
• Publication date: 2025-03-01
• Acceptance date: 2025-01-27
• DOI: 10.1093/rheumatology/keaf126
• EISSN: 1462-0332
• ISSN: 1462-0324
• Language: English
• Keywords: prescribing; pain management; osteoarthritis; steroid injection; pharmaco-epidemiology