Intra‐articular corticosteroid injections during the COVID‐19 lockdown period: A service evaluation

Newton, Ayla C; Jones, Georgina; Jones, John; Norris, Rory; Barabas, Anthony

doi:10.1002/msc.1530

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…Extensive counselling and written consent process including the discussion of the risks and benefits of the CSI prior to receiving the injection may have led to greater caution being shown by the participants and taking more precautions with regards to social contact and self‐isolation/distancing and carrying out more effective hand hygiene measures in the knowledge that the steroid can reduce the immune response. The findings of this study are consistent with and in keeping with other studies (Aziz et al., 2021 ; Bugeja et al., 2021 ; Chang et al., 2021 ; McKean et al., 2020 ; Morgan & Dattani, 2020 ; Newton et al., 2021 ; Regan et al., 2021 ). The risk identified within those studies demonstrated extremely low infection risk with very few or no positive cases of COVID‐19 infection following CSI.…”

Section: Discussionsupporting

confidence: 93%

Steroid injections in musculoskeletal conditions and COVID infection rates: What is the impact on positive rates following the injection?

Lethbridge

O’Shea

2022

Musculoskeletal Care

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Background and Aim Therapeutic glucocorticosteroid injections are commonly utilised to manage musculoskeletal (MSK) complaints. Following the SARS‐CoV‐2 pandemic, national guidelines advised against their use due to potential immunosuppressant effects. The aim of the study was to determine whether steroid injections for MSK conditions impacts on positive COVID 19 infection rates. Patients and Methods This retrospective evaluation involved primary care participants who received a steroid injection for a MSK condition. 291 participants receiving a total of 299 steroid injections entered the study between the 25 September 2020 and the 29 April 2021. Results Six participants had positive polymerase chain reaction (PCR) tests, averaging 22.83 days (SD 10.48) after the injection. An infection rate of 2.06% was demonstrated in the injection group with the control group demonstrating 6.97% ( p = 0.000752) with statistical significance set at p = 0.05. The odds ratio was identified as 0.27 indicating a lower odds of a positive PCR test compared with the control group. Conclusions This retrospective evaluation found a low risk of positive PCR tests for low and moderate COVID‐19 risk patients injected during the COVID‐19 pandemic. Glucocorticosteroid injections within the COVID‐19 pandemic were not associated with higher COVID‐19 rates compared to the local population, in fact, they were related to lower rates. For future studies, large scale studies and meta analyses are needed to provide greater generalisation to the population.

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Section: Discussionsupporting

confidence: 93%

Steroid injections in musculoskeletal conditions and COVID infection rates: What is the impact on positive rates following the injection?

Lethbridge

O’Shea

2022

Musculoskeletal Care

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“…(Italian Society of Muscles, Ligaments and Tendons), that highlighted the importance of selecting patients not affected by COVID-19 (for example recognizing some musculoskeletal symptoms such as fatigue, myalgia and arthralgia that have been related to the novel Coronavirus ( 8)), to practice injections by implementing all the most appropriate measures to protect healthcare workers and patients from contagion, and to guarantee the maximum sterility and safety during the injection procedure (9). Furthermore, several studies showed how corticosteroid injections are safe and could be performed during the pandemic since they are not associated with a higher infection rate compared to the general population (10)(11)(12)(13). Infiltrative therapy has short-term effects on articular pain and stiffness, so it must be cyclically repeated, approximately every 6-12 months (depending on the underlying condition and on the used drug).…”

Section: Infiltrative Treatment For Musculoskeletal Disorders During the Sars-cov-2 Pandemicmentioning

confidence: 99%

The Effects of SARS-CoV-2 Pandemic Countermeasures on Patients Receiving Infiltrative Treatment for Musculoskeletal Disorders: a Study from an Italian Cohort

Tarantino¹,

Gnasso²,

Sirico³

et al. 2021

Muscle Ligaments and Tendons J

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Background. COVID-19 outbreak had a massive worldwide impact and several countermeasures to contain its spread have been adopted, such as the interruption of non-urgent outpatient clinics. We wanted to describe the effects of the national lockdown on the well-being of a cohort of Italian patients with musculoskeletal disorders receiving infiltrative treatment. Methods. 40 patients who received intra-or peri-articular treatment were surveyed using a structuralised questionnaire that assessed their well-being during the first national lockdown. Results. 24 out of 40 patients (60%) did not come back after the re-opening of the Clinic because they were afraid of the pandemic. Of these 24 patients, the 83.3% noticed increased pain and stiffness in the joint. Due to the lockdown, the patient's quality of life was reduced by 61.66 ± 15.72%. After the lockdown, for the 92% of patients, the infiltrative treatment was perceived as more important than before, the 83% of patients perceived long-term security of infiltrative therapy availability as very important, and the 72% of the patients perceived the lockdown as inadequate. Conclusions. The infiltrative outpatient clinic's interruption was seen to significantly worsen the physical condition of subjects with musculoskeletal disorders, with an important increase in both articular pain and stiffness. Therefore, any kind of infiltrative treatment suspension or delay should be avoided.

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“…Secondly, and specifically related to the COVID-19 pandemic where elective surgeries are postponed, preoperative ICIs are effective in improving patient quality-of-life during the delay to surgery. Reassuringly, studies of patients given ICI during the COVID-19 pandemic in the UK did not show any increase in COVID-19 infection or adverse effects [ 77 , 78 ]; therefore, ICI may be a safe and viable option. Of note, while ICI clinics may also work at reduced capacities during the pandemic, reinstating ICI clinics could be a practical and more feasible approach to combat the significant delays in elective surgeries.…”

Section: Introductionmentioning

confidence: 99%

Perioperative use of intra-articular steroids during the COVID-19 pandemic

Jou

Zhou

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose There are growing concerns with the widely used glucocorticoids during the Coronavirus disease-19 (COVID-19) pandemic due to the associated immunosuppressive effects, which may increase the risk of COVID-19 infection and worsen COVID-19 patient outcome. Heavily affecting orthopaedics, the pandemic led to delay and cancellation of almost all surgical cases, and procedures including perioperative intra-articular corticosteroid injections (ICIs) saw similar decreases. However, the benefits of ICI treatments during the pandemic may outweigh these potential risks, and their continued use may be warranted. Methods A literature search was conducted, and all relevant articles including original articles and reviews were identified and considered in full for inclusion, and analysed with expert opinion. Epidemiological statistics and medical guidelines were consulted from relevant authorities. Results ICIs allow a targeted approach on the affected joint and are effective in reducing pain while improving functional outcome and patient quality-of-life. ICIs delay the requirement for surgery, accommodating for the increased healthcare burden during the pandemic, while reducing postoperative hospital stay, bringing significant financial benefits. However, ICIs can exert systemic effects and suppress the immune system. ICIs may increase the risk of COVID-19 infection and reduce the efficacy of COVID-19 vaccinations, leading to important public health implications. Conclusion Perioperative ICI treatments may bring significant, multifaceted benefits during the pandemic. However, ICIs increase the risk of infection, and perioperative COVID-19 is associated with mortality. The use of ICIs during the COVID-19 pandemic should therefore be considered carefully on an individual patient basis, weighing the associated risks and benefits.

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Intra‐articular corticosteroid injections during the COVID‐19 lockdown period: A service evaluation

Cited by 5 publications

References 27 publications

Steroid injections in musculoskeletal conditions and COVID infection rates: What is the impact on positive rates following the injection?

Steroid injections in musculoskeletal conditions and COVID infection rates: What is the impact on positive rates following the injection?

The Effects of SARS-CoV-2 Pandemic Countermeasures on Patients Receiving Infiltrative Treatment for Musculoskeletal Disorders: a Study from an Italian Cohort

Perioperative use of intra-articular steroids during the COVID-19 pandemic

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