Intended for healthcare professionals

  1. Fraser Birrell, professor1 2 3,
  2. Ann Johnson, patient and public involvement and engagement representative4
  1. 1Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing, Newcastle University, Newcastle Upon Tyne, UK
  2. 2Rheumatology, Northumbria Healthcare NHS Foundation Trust, Northumberland and North Shields, UK
  3. 3Faculty of Health and Life Sciences, Northumbria University, Northumberland and North Shields, UK
  4. 4Masters of Clinical Research Programme, Newcastle University, Newcastle Upon Tyne, UK
  1. Correspondence to: F Birrell Fraser.Birrell{at}

Lessons from the Hip Injection Trial (HIT)

Rheumatology practice has rapidly progressed in the past three decades, including many new evidence-based treatment options and strategies for patients with inflammatory arthritis. Treatment options for osteoarthritis remain scarce, however, and might decrease further once osteoarthritis guidance from the UK’s National Institute for Health and Care Excellence is updated later this year.1 A recommendation not to use paracetamol is highly probable because of its lack of efficacy, its established toxicities that worsen when combined with other non-steroidal anti-inflammatory agents,2 and a proposal already made during consultation for the previous guideline (known as CG177).3

In a linked article, Paskins and colleagues (doi:10.1136/bmj-2021-068446) conducted a large, randomised controlled trial including 199 adults aged 40 years or older with hip osteoarthritis and at least moderate pain.4 Over six months, the trial compared guided local anaesthetic injection with or without triamcinolone acetonide to best current treatment (including standard and bespoke written information and personalised advice). The primary outcome of current hip pain intensity (0-10 Numerical Rating Scale) improved significantly among participants given the combined local anaesthetic (lidocaine) and corticosteroid injections (triamcinolone) in comparison with the control group that was given best current treatment alone (mean difference −1.43 (95% confidence interval −2.15 to −0.72), P<0.001; standardised mean difference −0.55 (−0.82 to −0.27)). Participants in the combined intervention group had their pain scores halved at two weeks, with a …

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