Evidence map›Paper›PMID 40036958›Full record

ArticleRheumatology (Oxford, England)2025

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

Samuel Hawley, Albert Prats-Uribe, Gulraj S Matharu, Antonella Delmestri, Daniel Prieto-Alhambra, Andrew Judge, Michael R Whitehouse

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Samuel HawleyMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building Level 1, Bristol, UK.ORCID 0000-0002-7034-6168
Albert Prats-UribeCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.ORCID 0000-0003-1202-9153
Gulraj S MatharuMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building Level 1, Bristol, UK.
Antonella DelmestriCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.
Daniel Prieto-AlhambraCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.ORCID 0000-0002-3950-6346
Andrew JudgeMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building Level 1, Bristol, UK.ORCID 0000-0003-3015-0432
Michael R WhitehouseMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building Level 1, Bristol, UK.

Funding

Academy of Medical SciencesAstraZenecaEuropean Medicines AgencyEuropean Medicines Agency, Innovative Medicines InitiativeHealthcare Quality Improvement PartnershipHealthcare Quality Improvement Partnership and CeramtecNational Institute for Health and Care Research NIHR129011Royal College of Physicians and Tommy's Health FoundationVersus Arthritis
6 · The paper itself

Abstract

objectivesTo estimate the effect of intra-articular corticosteroid injection (IACI) for osteoarthritis on longer-term incidence of pain medications.

methodsWe 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 and 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.

resultsAmongst 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 (95% CI: 5-6), P < 0.001] and uncombined opioids following repeat IACI [NNT = 12 (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.

conclusionsIACI 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.

Indexed as

Adrenal Cortex HormonesAnalgesicsOsteoarthritisAcetaminophenAgedAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalCohort StudiesFemaleHumansInjections, Intra-ArticularMaleMiddle AgedOsteoarthritis, HipOsteoarthritis, KneeAcetaminophenAdrenal Cortex HormonesAnalgesicsAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-Steroidalosteoarthritispain managementpharmaco-epidemiologyprescribingsteroid injection

Identifiers

PMID40036958
PMCPMC12107031

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.