Patterns of intra-articular injection use after initiation of treatment in patients with knee osteoarthritis: data from the osteoarthritis initiative

Osteoarthritis Cartilage. 2017 Oct;25(10):1607-1614. doi: 10.1016/j.joca.2017.05.023. Epub 2017 Jun 13.

Abstract

Objective: We sought to describe and evaluate longitudinal use of intra-articular injections after treatment initiation among adults with radiographically confirmed knee osteoarthritis (OA).

Method: Using data from the Osteoarthritis Initiative (OAI), we included participants with radiographically confirmed OA (Kellgren-Lawrence grade (K-L) ≥ 2) in ≥1 knee at baseline. With 9 years of data, 412 participants newly initiating hyaluronic acid or corticosteroid injections with their index visit were identified. For each type of injection initiated, socio-demographic and clinical characteristics were described by patterns of treatments (one-time use, switched, or continued injections). Multinomial logistic models estimated the extent to which patient-reported symptoms (post-initial injection and changes over time) were associated with patterns of injection use.

Results: Of those initiating injections, ∼19% switched, ∼21% continued injection type, and ∼60% did not report any additional injections. For participants initiating corticosteroid injections, greater symptoms post-initial injection were associated with lower odds of continued use compared to one-time users (adjusted odds ratio (aOR) for Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain: 0.91; 95%, confidence interval (CI): 0.83 to 0.99; aORstiffness: 0.77; CI: 0.63 to 0.94; aORphysical function: 0.97; CI: 0.94 to 1.00). Symptom changes over time (e.g., worsened or improved) were not associated with patterns of injections use.

Conclusion: After treatment initiation, the proportion of patients switching injection use and one-time users was substantial. Symptoms post-initial injection appear to be associated with patterns of injection use. The extent to which these patterns are an indication of lack of impact on patient-reported symptoms should be explored.

Keywords: Discontinuation; Intra-articular injections; Knee osteoarthritis; Longitudinal studies; Switching.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Drug Substitution / statistics & numerical data
  • Drug Utilization / statistics & numerical data
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Injections, Intra-Articular
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / drug therapy*
  • Pain Measurement / methods
  • Radiography
  • Retrospective Studies
  • Severity of Illness Index
  • Socioeconomic Factors
  • Viscosupplements / administration & dosage*

Substances

  • Glucocorticoids
  • Viscosupplements
  • Hyaluronic Acid