RUbICOn: RecUrrent intra-articular corticosteroid injections in osteoarthritis


National Institute for Health (NIHR) Health Technology Assessment (HTA) Ref. NIHR129011

What is the research question?

To establish the current practice of use, long term effects, and experiences of, intra-articular corticosteroid injection for the treatment of joint pain due to osteoarthritis.

What is the problem?

Osteoarthritis is a condition that causes joints to become painful and stiff, it is a common cause of pain and disability. Management of osteoarthritis involves reducing pain and maintaining function. Simple treatments include activity modification, staying active to maintain muscle strength and taking pain medication. Complex treatments include joint replacement (replacing the painful joint with an artificial joint), which may be required for those with pain that cannot be well controlled by other means. Before a joint replacement is considered, it is possible to use other techniques, such as injections into the affected joint, to try to reduce pain. These injections are most commonly used for knee osteoarthritis. The injection usually contains both an anaesthetic to help with the pain and a steroid to reduce the inflammation (swelling, redness, heat and pain) within the joint. It is known that these injections can help with pain if used infrequently and that their use is recommended by a variety of organisations, including the NHS. However, little is known about the effect of using repeated injections.

What is the aim of the research?

To understand how these injections are currently used and how practice and care for patients could be improved. It will also help to find out what future research in this area is needed and the most acceptable way of doing this.

How will this be achieved?

We wish to use data that has already been collected on patients treated for osteoarthritis in primary care (by their GP or a physiotherapist) who have or have not received an injection. Using this data, we will look at current use of injections, the safety of their use, how good they are, and whether they affect other treatments and the timing of these. We will also interview people involved in this treatment (patients and healthcare professionals) to help understand their experience of the treatment, attitudes to its use, how best it can be used, the acceptability of future research in this area, and what the most important outcomes that should be assessed are. We will also invite patients, healthcare professionals and commissioners to take part in questionnaire surveys to find out what the important questions are that need to be answered by any studies in the future, whether it would be possible to do these studies and how they should be conducted.

Who is leading the research?

Mr Michael Whitehouse, Reader in Trauma & Orthopaedics, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol.

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The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.