Musculoskeletal steroid injections during the COVID-19 pandemic

Bugeja, Mark; Mariani, Jasmine; Dowling, Jessica; Stringaro, Giulia; Portelli, J.; Sant, Kurstein; Casaletto, John A.

doi:10.1016/j.jor.2021.07.017

Cited by 9 publications

(33 citation statements)

References 6 publications

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“…A prior prospective study by our group showed no evidence of an increased risk of COVID-19 during the lockdown period of the current pandemic ( 23 ). Additional retrospective studies with cohorts ranging from 30 to 734 participants have shown similar results since then ( 19 , 24 – 26 ). The findings during the recovery period in our state further support the safety of intra-articular and spine corticosteroid injections during the COVID-19 pandemic.…”

Section: Discussionsupporting

confidence: 55%

“…The results of studies evaluating individuals who received injections during the lockdown period have been reassuring, but the changes in public health policies, including decreased physical distancing and the reopening of businesses, and potentially higher exposure when vaccines were not yet available, warrant additional investigation about the safety profile of corticosteroid injections during the COVID-19 pandemic ( 19 , 23 – 26 ).…”

Section: Introductionmentioning

confidence: 99%

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Relationship of Imaging-guided Corticosteroid Injections to COVID-19 Incidence in the Pandemic Recovery Period

et al. 2023

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Background Corticosteroids injected for the treatment of musculoskeletal pain are systemically absorbed and can affect the immune response to viral infections. Purpose To determine the incidence of symptomatic COVID-19 disease in individuals receiving image-guided corticosteroid injections for musculoskeletal pain compared with the general population during the pandemic recovery period. Materials and methods In this prospective cohort multicenter study, adults with a history of musculoskeletal pain who underwent imaging-guided intra-articular and spine corticosteroid injections between April 2020 and February 2021 were consecutively enrolled. Participants were followed for a minimum of 28 days through their electronic medical record (EMR) or by direct phone call to screen for COVID-19 test results or symptoms. Clinical data including body mass index (BMI) was also obtained from the EMR. Incidence of COVID-19 in the state was obtained using the Massachusetts COVID-19 Response Reporting website. Student t tests were used for continuous variable comparisons. Univariable analyses were performed using Fisher exact tests. Results A total of 2714 corticosteroid injections were performed for 2190 adult participants (mean age ± standard deviation, 59 ± 15 years, 1031 women). Follow-up was available for 1960 (89%) participants who received 2484 injections. Follow-up occurred 97 ± 33 days (range 28 – 141 days) after the injection. There were 10/1960 participants with COVID-19 within 28 days from the injection (0.5%, 95% CI, 0.24-0.94%) and 43/1960 participants with COVID-19 up to 4 months after the injection (2.2% 95%CI, 1.6-2.9%). This was lower than the incidence rate in the population of Massachusetts during the same period (519,195/6,892,503, 7.5%, P <.001 both at 28 days and 4 months). Participants diagnosed with COVID-19 (n=10) at 28 days had higher BMI than the entire cohort (n=1960) (32 ± 10 vs. 28 ± 6 kg/m 2 , P=.04). Conclusion Adults who received image-guided corticosteroid injections for pain management performed during the pandemic recovery period had a lower incidence of symptomatic COVID- 19 compared with the general population.

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Relationship of Imaging-guided Corticosteroid Injections to COVID-19 Incidence in the Pandemic Recovery Period

et al. 2023

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“…In some patients, COVID-19 infection precipitously progresses, and respiratory failure can occur [ 3 ]. Therefore, prognostic factors for COVID-19 progression were investigated to provide a basis on which to optimize hospital efforts, further improve patient management and make therapy more effective, hoping to reduce mortality [ 4 , 5 ]. Gender, age, underlying comorbidities (diabetes, hypertension, cardiovascular disease), respiratory rate, temperature, neutrophil and lymphocyte counts, D-dimer, albumin and procalcitonin are all predictors of COVID-19 severity, and therefore can be considered risk factors for admission to intensive care unit (ICU) [ 6 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vitamins C and D and COVID-19 Susceptibility, Severity and Progression: An Evidence Based Systematic Review

et al. 2022

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Background and Objectives: Starting in early December 2019, the novel Coronavirus Disease (COVID-19) from infection with COVID-19 has caused a global pandemic. Many aspects of its pathogenesis and related clinical consequences are still unclear. Early diagnosis and dynamic monitoring of prognostic factors are essential to improve the ability to manage COVID-19 infection. This study aimed to provide an account of the role played by vitamins C and D on the onset, progression and severity of COVID-19. Clinical features and infection-related risk factors are also briefly discussed. Material and Methods: In March 2022, the main online databases were accessed. All the articles that investigate the possible role of vitamins C and D on COVID-19 susceptibility, severity and progression were considered. Results: The current evidence on vitamin C and D supplementation in patients with COVID-19 infection is inconsistent and controversial. In some studies, vitamins were used as coadjuvant of a formal experimental therapy, while in others as main treatment. Ethnicity and hospital setting (inpatient/outpatient) were also variable. Moreover, there was no consensus between studies in administration protocol: high heterogeneity in dosage, administration, and duration of the treatment were evident. Finally, some studies administered vitamins pre- and/or during COVID infection, in patients with different risk factors and infection severity. Conclusions: While waiting to develop a targeted, safe and effective therapy, it is important to investigate individual predisposition and proper disease management. Concluding, available data on the use of nutraceuticals in COVID-19 are inconsistent. However, there is a lack of evidence-based guidelines which recommend vitamin C and D supplementation in patients with COVID-19, and results from high quality randomised controlled trials (RCTs) are inconsistent. Current investigations so far are mostly observational, and include a relatively small sample size which can lead to biased results. Large-scale multicentre studies are therefore needed.

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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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Musculoskeletal steroid injections during the COVID-19 pandemic

Cited by 9 publications

References 6 publications

Relationship of Imaging-guided Corticosteroid Injections to COVID-19 Incidence in the Pandemic Recovery Period

Relationship of Imaging-guided Corticosteroid Injections to COVID-19 Incidence in the Pandemic Recovery Period

Vitamins C and D and COVID-19 Susceptibility, Severity and Progression: An Evidence Based Systematic Review

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

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