Corticosteroid Injections and COVID-19 Infection Risk

Miller, David C.; Patel, Jaymin; Gill, Jatinder; Mattie, Ryan; Saffarian, Mathew; Schneider, Byron J.; Popescu, Adrian; Babaria, Vivek; McCormick, Zachary L.

doi:10.1093/pm/pnaa199

Cited by 25 publications

(28 citation statements)

References 19 publications

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“…Same guidelines were also published in America. Miller et al 10 on behalf of the Spine Intervention Society (SIS) published a clinical perspective paper stating that patients without severe pain should postpone their corticosteroid injection until after the COVID-19 pandemic abates. In March 2020, the American Society of Regional Anaesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) issued a joint statement advising clinicians to use musculoskeletal corticosteroid injection with caution and to use a lower dose, especially in high risk individuals.…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal steroid injections during the COVID-19 pandemic

Bugeja

Mariani

Dowling

et al. 2021

Journal of Orthopaedics

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Introduction This study aims to determine whether musculoskeletal corticosteroid injections increase the risk for COVID-19. Method 734 patients who received a corticosteroid injection during the COVID-19 pandemic were followed and their COVID status within 30 days after the injection checked. The results were then compared with an age and sex matched control group. Results No statistically significant difference in the frequency of COVID-19 cases between the two groups was found. Conclusion It appears that the use of musculoskeletal corticosteroid injections during the COVID-19 pandemic does not confer increased risk of contracting the virus.

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Section: Introductionmentioning

confidence: 99%

Musculoskeletal steroid injections during the COVID-19 pandemic

Bugeja

Mariani

Dowling

et al. 2021

Journal of Orthopaedics

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“…The use of corticosteroid for interventional procedures has been a controversial topic during the COVID-19 pandemic as many are concerned about the potential immunosuppressive effect of corticosteroids. While there is no clear evidence of causative effect between spinal administration of corticosteroids and infection [ 6 ], one study reported increased risk of developing influenza after receiving a major joint corticosteroid injection [ 7 ]. With regard to anticoagulation, early reports reveal high rates of thrombotic events in COVID-19 patients resulting in deep vein thromboses, pulmonary emboli, and stroke [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Reopening Interventional Pain Practices during the Early Phase of the COVID-19 Global Pandemic

et al. 2021

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Objective Examine how interventional pain physicians navigated the early phase of reopening practices during the coronavirus disease 2019 (COVID-19) pandemic. Methods In June/July 2020, Spine Intervention Society members were queried about practice demographics, perception of COVID-19 prevalence, financial impact, and implementation of new tools and procedures when re-opening practices. Results Of the 2,295 members approached, 195 (8%) completed the survey. A majority (71%) reported using risk stratification tools and changing scheduling patterns. Nearly 70% performed initial assessments via telehealth and 87% for follow-up encounters. More than 80% performed symptom/temperature checks upon in-person clinic/facility entrance, and 63% screened patients via phone. Most (58%) did not test patients for COVID-19 for office visits, while 38% tested only if symptomatic. For epidural injections, intra-articular injections, and radiofrequency neurotomy procedures, 43% reported not testing patients, while 36% tested patients only if symptomatic. Most (70%) required patients to wear a mask upon entering the clinic/facility. For nonprocedure encounters, respondents used surgical masks (85%), gloves (35%), face shields/goggles (24%), N95 respirators (15%), and gowns (6%). Some (66%) discussed unique COVID-19 risks/complications and 26% provided written information. Most did not make changes to steroid dosage (67%) or peri-procedural anticoagulation management (97%). The vast majority (81%) estimated that COVID-19 will have a moderate-severe financial impact on their practice. Conclusions COVID-19 has dramatically affected interventional pain practices with regard to telehealth, in-clinic precautions, screening/testing protocols, and patient counseling. Practice patterns will continue to evolve as we learn more about the disease and improve methods to provide safe and effective care.

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“…The use of intraarticular corticosteroids was previously associated with an increased risk for developing influenza despite vaccination [101]. Due to the long-lasting systemic effects of intraarticular corticosteroid injections and the time to establish an effective response of the adaptive immune system, it is suggested to conduct an elective corticosteroid injection no less than two weeks prior and one week following mRNA vaccine dose, whenever possible [102,103]. However, on the other hand, there are also studies that do not see any connection between vaccine responsiveness and short-term systemic GC administration [100,104,105].…”

Section: Glucocorticoids and Sars-cov-2 Mrna Vaccinesmentioning

confidence: 99%

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Vogel

Reincke

2021

Rev Endocr Metab Disord

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Patients with endogenous or exogenous glucocorticoid (GC) excess exhibit a range of side effects, including an increased risk of infections. Via both mechanism, immune impairments and cardiometabolic concomitant diseases, patients with GC excess could be at increased risk for COVID-19. The impact on incidence and outcome of a SARS-CoV-2 infection in this population are not yet completely clear. This review aims to compile the data available to date and to discuss the existing literature on this topic. Further we highlight potential effects of SARS-CoV-2 on the hypothalamic-pituitary-adrenal axis as well as the influence of endogenous or exogenous GC excess on SARS-CoV-2 mRNA vaccination. There is growing evidence suggesting an increased risk of infection and severe outcome in patients with high-dose GC therapy after contracting SARS-CoV-2. The few data and case reports on patients with endogenous GC excess and SARS-CoV-2 infection point in a similar direction: chronic GC excess seems to be associated with an unfavorable course of COVID-19. Whether this is mainly a primary immune-mediated effect, or also triggered by the many GC-associated comorbidities in this population, is not yet fully understood. Patients with endogenous or exogenous GC excess should be considered as a vulnerable group during the SARS-CoV-2 pandemic. Regardless of the cause, vaccination and consistent surveillance and control of associated comorbidities are recommended.

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Corticosteroid Injections and COVID-19 Infection Risk

Cited by 25 publications

References 19 publications

Musculoskeletal steroid injections during the COVID-19 pandemic

Musculoskeletal steroid injections during the COVID-19 pandemic

Reopening Interventional Pain Practices during the Early Phase of the COVID-19 Global Pandemic

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

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