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RecUrrent Intra-articular Corticosteroid injections in Osteoarthritis: the RUbICOn mixed-methods study.

Michael Richard Whitehouse1,2, Andrew Judge1,2, Samuel Hawley1

  • 1Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Health Technology Assessment (Winchester, England)
|November 11, 2025
PubMed
Summary

Intra-articular corticosteroid injections for osteoarthritis show sustained pain medication reduction and appear safe, though regional access varies. Further research is needed on potential safety signals and optimizing patient care.

Keywords:
ADRENAL CORTEX HORMONESANKLEARTHRALGIACONSENSUSEFFECTIVENESSELBOWEPIDEMIOLOGYFEASIBILITY STUDIESFOLLOW-UP STUDIESHANDHIPINCIDENCEINJECTIONKNEEOSTEOARTHRITISPRESCRIPTIONSPREVALENCEPROPENSITY SCORERESEARCH PRIORITIESSAFETYSHOULDERSTEROIDTELEPHONEUTILISATIONWRIST

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Area of Science:

  • Orthopedics and Musculoskeletal Health
  • Pharmacology and Therapeutics
  • Health Services Research

Background:

  • Intra-articular corticosteroid injections are commonly used for osteoarthritis.
  • Uncertainty exists regarding their long-term benefits and risks, especially with recurrent use.
  • This research aimed to address these uncertainties.

Purpose of the Study:

  • To characterize current intra-articular corticosteroid injection practices.
  • To establish longer-term effects and safety of these injections.
  • To explore patient and clinician perspectives and identify future research priorities.

Main Methods:

  • A large UK cohort study using linked primary care and hospital data (2005-20).
  • Instrumental variable analysis for treatment effects and propensity score matching for safety.
  • Qualitative interviews with patients and clinicians, and a modified Delphi study for research priorities.

Main Results:

  • Intra-articular corticosteroid injection use remained stable but showed regional variation.
  • Injections were associated with reduced pain medication use and lower knee replacement incidence.
  • Generally safe, with some numerical increases in diabetes and cardiovascular events needing further investigation.

Conclusions:

  • Intra-articular corticosteroid injections offer sustained benefits in pain medication reduction for osteoarthritis.
  • While generally safe, further research into specific safety signals is warranted.
  • Addressing regional variations in access and clinician confidence is crucial for optimal patient care.