Do Intra-articular Steroid Shots Cut Pain Killer Use in OA?

TOPLINE: 

A single intra-articular corticosteroid injection for knee or hand osteoarthritis was associated with a reduced use of most pain medications over 5 years, with a secondary analysis showing a reduced incidence of combined opioid and non-opioid analgesic use after a single injection in knee, hip, hand, and shoulder osteoarthritis.

METHODOLOGY:

• This cohort study used a primary care database in the United Kingdom to assess the effects of single or repeated intra-articular corticosteroid injections on the long-term use of pain medications in incident osteoarthritis.
• Overall, 74,527 patients diagnosed with knee osteoarthritis (mean age, 65.5 years; 55.9% women), 15,092 with hand osteoarthritis (mean age, 63.2 years; 71.5% women), 28,558 with hip osteoarthritis (mean age, 66.5; 57.6% women), and 1403 with shoulder osteoarthritis (mean age, 65.6%; 48.6% women) between 2005 and 2019 were included.
• The main exposure was the single or repeated use of intra-articular corticosteroid injection at one of the joints.
• Primary outcomes included the 5-year incidence of uncombined opioid use, combined opioid and non-opioid analgesic use, oral corticosteroid use, paracetamol use, and oral and topical non-steroidal anti-inflammatory drug (NSAID) use.
• Incidence rate ratios were expressed as the number needed to treat (NNT) with injections to prevent a single new outcome event over 5 years. The secondary analyses included the estimation of propensity scores and the assessment of the association between injection use and outcomes using the Cox proportional hazard model.

TAKEAWAY:

• A single intra-articular corticosteroid injection for knee osteoarthritis was associated with a reduced incidence of combined opioid and non-opioid analgesic use (NNT, 5; P < .001), oral corticosteroid use (NNT, 18; P = .011), paracetamol use (NNT, 4; P < .001), and oral NSAID use (NNT, 10; P = .046).
• Repeated injections for knee osteoarthritis led to slightly larger reductions in the incidence of uncombined opioid use (NNT, 12; P = .049), combined opioid and non-opioid analgesic use (NNT, 5; P < .001), and paracetamol use (NNT, 4; P < .001).
• A single injection for hand osteoarthritis was associated with a reduced incidence of combined opioid and non-opioid analgesic use, paracetamol use, and oral NSAID use (P < .01 for all).
• Propensity score–matched secondary analyses showed a reduced incidence of combined opioid and non-opioid analgesic use after a single intra-articular corticosteroid injection for knee (hazard ratio [HR], 0.88; 95% CI, 0.81-0.96), hip (HR, 0.76; 95% CI, 0.62-0.92), hand (HR, 0.77; 95% CI, 0.61-0.98), and shoulder (HR, 0.72; 95% CI, 0.53-0.99) osteoarthritis.

IN PRACTICE:

“Our findings suggest short-term pain reduction following IACI [intra-articular corticosteroid injection] may translate to longer-term benefits in terms of less need for various pain medications after injection, including stronger medications such as opioids,” the authors wrote.

SOURCE:

The study was led by Samuel Hawley, Bristol Medical School, University of Bristol, Bristol, United Kingdom. It was published online on March 1, 2025, in Rheumatology.

LIMITATIONS: 

Even though osteoarthritis identification was validated in the datalink, the recorded diagnosis dates may not accurately represent the actual disease onset. The use of Read codes to identify osteoarthritis may have resulted in capturing later disease stages, as earlier manifestations might have been recorded as joint pain rather than a definitive osteoarthritis diagnosis. Researchers did not differentiate between primary and secondary osteoarthritis.

DISCLOSURES:

This study was funded by the National Institute for Health and Care Research. Several authors reported receiving research funding or having other financial ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.