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

Hawley, S; Prats-Uribe, A; Matharu, GS; Delmestri, A; Prieto-Alhambra, D; Judge, A; Whitehouse, MR

doi:10.1093/rheumatology/keaf126

Osteoarthritis

Effect of intra-articular corticosteroid injections for osteoarthritis on the subsequent use of pain medications: a UK Clinical Practice Research Datalink (CPRD) cohort study

Rheumatology (Oxford)Published 1 Mar 2025Retrospective cohort study

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Authors' conclusion

IACI for knee or hand osteoarthritis showed lower incidence of several pain medications over the longer-term relative to no IACI use.

Study context

Population: Patients in the UK CPRD GOLD primary care database with incident knee, hip, hand or shoulder OA, 2005–201974,527 knee OA

Exposure: Single or repeated intra-articular corticosteroid injection (IACI) vs no IACI use
Outcome: Incidence of uncombined opioids, opioid-nonopioid analgesic combinations, oral corticosteroids, paracetamol, oral NSAIDs and topical NSAIDs
Follow-up: 5 years

Methodological detailsinstrumental variable analysis, secondary analyses: propensity-score matching and Cox regression

Instrumental variable analysis
Secondary analyses: propensity-score matching and Cox regression

Main finding

As reported in the abstract

Pain medication prescribing, knee OA (instrumental variable (IV) analysis)

NNT

5

95% CI 5–6P < 0.001

Single IACI · opioid-nonopioid analgesic combinations

NNT

12

95% CI 8–546P = 0.049

Repeat IACI · uncombined opioids

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with single IACI ←→ Higher risk with single IACI →	HR (CI)
Opioid-nonopioid combinations after single IACI, by joint (secondary analyses)Single IACIvs No IACIKnee OA · propensity-score matching and Cox regression	0.512	0.88 (0.81–0.96)
Opioid-nonopioid combinations after single IACI, by joint (secondary analyses)Single IACIvs No IACIHip OA · propensity-score matching and Cox regression	0.512	0.76 (0.62–0.92)
Opioid-nonopioid combinations after single IACI, by joint (secondary analyses)Single IACIvs No IACIHand OA · propensity-score matching and Cox regression	0.512	0.77 (0.61–0.98)
Opioid-nonopioid combinations after single IACI, by joint (secondary analyses)Single IACIvs No IACIShoulder OA · propensity-score matching and Cox regression	0.512	0.72 (0.53–0.99)
	0.512Hazard ratio (log scale)

Reference

Authors: Hawley S, Prats-Uribe A, Matharu GS, Delmestri A, Prieto-Alhambra D, Judge A, et al.
All 7 authors
Hawley S, Prats-Uribe A, Matharu GS, Delmestri A, Prieto-Alhambra D, Judge A, Whitehouse MR
Journal: Rheumatology (Oxford)
Published: 1 Mar 2025
DOI: 10.1093/rheumatology/keaf126
PubMed: 40036958

Topic: Osteoarthritis

Exposure definitions

Single IACI: single use of intra-articular corticosteroid injection
Repeat IACI: repeated use of intra-articular corticosteroid injection (analysed separately)

Key notes

Knee OA: IACI use associated with lower subsequent prescribing of most pain medications studied
Hand OA: single IACI associated with reduced use of opioid-nonopioid combinations, paracetamol and oral non-steroidal anti-inflammatory drugs (NSAIDs)

More notes

74 527 knee OA; 15 092 hand OA

Original publication

Effect of intra-articular corticosteroid injections for osteoarthritis on the subsequent use of pain medications: a UK CPRD cohort study. Rheumatology (Oxford). Published 1 March 2025. doi:10.1093/rheumatology/keaf126

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