Risk of SARS‐CoV‐2 following joint and epidural corticosteroid injections: A retrospective study

Abstract

ObjectiveThe immunosuppressive effects of corticosteroid (CS) injections have come under more scrutiny during the coronavirus disease 2019 (COVID‐19) pandemic. The aim of the study was to explore any relationship between joint/epidural CS injection and SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction (PCR) positivity.MethodsA retrospective chart review was conducted on patients 18 years or over who received at least one joint or epidural CS injection by physiatrists in a tertiary care center between January 1, 2020, and December 31, 2021. This cohort of patients was then compared to a control group who did not receive any CS injection during this time period.ResultsA total of 766 patients were identified in the CS injection group and 1546 patients in the control group. Overall, 12.27% of patients turned SARS‐CoV‐2 PCR positive in the CS injection group, which was similar to 11.90% in the control group (p = 0.797). But 3‐month SARS‐CoV‐2 PCR positivity rate showed a statistically significant higher rate among the CS injection group (3.30% in the CS injection group vs. 2.10% in the control group; p = 0.027). In multivariate regression analysis, after adjusting both groups for Charlson Comorbidity Index (CCI), there was statistically significant higher SARS‐CoV‐2 PCR positivity rate in the CS injection group (p = 0.024). However, after adjusting both groups for age and total number of comorbidities, there was no difference between the groups in regard to SARS‐CoV‐2 PCR positivity rate (p = 0.081). In the subgroup analysis of only COVID‐19 vaccinated patients, there was an increased 3‐month SARS‐CoV‐2 PCR positivity rate among patients with severe comorbidities in the CS injection group (p = 0.036).ConclusionThe study was not conclusive on the effect of joint or epidural CS injection on SARS‐CoV‐2 PCR positivity rate, although adjusted analysis suggests higher 3‐month SARS‐CoV‐2 PCR positivity rate after CS injection in patients with severe comorbidities with significant disease burden when compared to controls.