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

Abstract

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.

Incidence and Risk Factors of Systemic Adverse Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections

“…However, this theoretical increased risk of developing a systemic infection did not translate into clinical findings. Two other retrospective studies found similar results and concluded that GCIs did not increase the likelihood of a COVID-19 infection 6,7 …”

“…As for the GCI versus non-GCI complication rate comparison, the control group was unmatched, which affected the comparison accuracy. The other studies that assessed the likelihood of developing a COVID-19 infection or an ACS after a GCI all had unmatched control groups as well to maximize the size of the control groups 4,6,7 …”

“…Two other retrospective studies found similar results and concluded that GCIs did not increase the likelihood of a COVID-19 infection. 6,7 Abnormal Uterine Bleeding…”

“…The other studies that assessed the likelihood of developing a COVID-19 infection or an ACS after a GCI all had unmatched control groups as well to maximize the size of the control groups. 4,6,7 All the GCIs performed at our hospital center were documented, but patients might have received GCIs from their general practitioner outside of our facilities, and those would have been missed in our total count. Furthermore, oral glucocorticoids were documented, but inhaled and topical glucocorticoid prescriptions were not, and those medications could have influenced our results as well.…”

Intervencionismo en dolor crónico y uso de corticoides en el riesgo de infección por SARS- Cov2

“…Se realizó el seguimiento de 1960 pacientes. Cabe destacar que los datos obtenidos respecto a la tasa de contagio de SARS-CoV-2 reflejan una menor incidencia acumulada en el periodo de seguimiento, si se comparan con los datos de la población general del área demográfica evaluada (9).…”