(014) Use of intra-articular corticosteroid injections among osteoarthritis patients in UK general practice

Publication Number: 678

Background: Intra-articular corticosteroid injections are recommended by NICE guidelines for Osteoarthritis (OA) patients as an adjunctive treatment for uncontrolled pain. However, data on current patterns of use is scarce.

Objectives: We aimed to establish current practice of use of intra-articular corticosteroid injection in osteoarthritis patients.

Methods: Study design: Cohort study using routinely collected data.
Setting: Data from general practice (CPRD GOLD) in UK linked to hospital data (HES).
Source population: Patients with a first diagnosis of OA on any studied joint (ankle and foot, elbow, hand, hip, knee, shoulder, or wrist) in the period 2005-2020.
Outcomes: Intra-articular injections of corticosteroids.
Statistical analysis: Incidence of first injection, as number of injections per 100 person-years (py), and yearly period prevalence, as number of injections per 100 OA patients, was estimated for each joint and stratified by calendar year, gender, and geographical region. Injections per OA patient and mean number of injections per injected patient were also calculated. Median time from OA diagnosis to injection for injected patients was calculated per each joint.

Results: 220,125 OA patients were identified, 58.8% women, with a mean age at diagnosis of 65. Of those, 23,899 patients were injected. Shoulder and knee OA patients had higher prevalence of injection during any time after their OA diagnosis, 15% and 13% respectively. The least injected joints were elbow and wrist (6% and 9%). Of those injected, around 40% had more than 1 injection. The joints with most injections per patient were the knee and hand (mean of 2 injections per injected patient). The earliest injected joint was shoulder, with a median time of 94 days after OA diagnosis, and knee, with 295 days. Incidence of first injection after OA was higher in women for most joints. Incidence of first injection in any joint was higher in Yorkshire & The Humber and East Midlands with incidences of 3.8 (95%CI 3.4-4.1) and 3.4 (3.0-3.7) injections per 100 py respectively. The regions with the lowest usage of injections were South East Coast with 1.2 (1.1-1.3) injections per 100 py, and South West with 1.4 (1.3-1.5). Incidence of injection was stable for all joints during the study period, except for a significant decline for all joints in 2020.

Conclusions: Around 1 out of 9 patients diagnosed with OA receive an intraarticular corticoid injection, and of those, 40% receive more than one. The most injected joints are shoulder and knee, and median time from OA to first injection for those joints is less than 1 year. The use of injections has been unchanged over time for the past 15 years, but there is wide heterogeneity in use of injections between UK regions.