Symptomatic COVID-19 infections in outpatient image-guided corticosteroid injection patients during the lockdown phase

Chang, Connie Y.; Prabhakar, Anand M.; Staffa, Steven J.; Husseini, Jad S.; Kheterpal, Arvin; Simeone, F. A.; Bredella, Miriam A.

doi:10.1007/s00256-020-03656-w

Cited by 11 publications

(18 citation statements)

References 26 publications

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“…A recent study by Chang et al also demonstrated no increased risk of COVID-19 infection following corticosteroid injection [ 13 ]. Out of 66 subjects who completed follow-up in 45 ± 22 (19–83) days after injection, 1 subject was positive for COVID-19 infection following injection.…”

Section: Discussionmentioning

confidence: 99%

“…Out of 66 subjects who completed follow-up in 45 ± 22 (19–83) days after injection, 1 subject was positive for COVID-19 infection following injection. The rate of infection was 1.52% [ 13 ]. The subject had mild symptoms that did not require any hospitalization [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The rate of infection was 1.52% [ 13 ]. The subject had mild symptoms that did not require any hospitalization [ 13 ]. A larger study with 504 steroid injections had a 2.7% rate of infection, of which 1.1% were asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the evidence of increased risk of systemic infection including COVID-19 following intra-articular and periarticular corticosteroid injection is limited. A recent study by Chang et al reported no significant elevation in the risk of developing COVID-19 infection following steroid injection compared to the general population [ 13 ]. McKean et al also demonstrate a low incidence of COVID-19 following corticosteroid injection with no major adverse outcomes [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe?

Aziz

Hanifah

Nahar

2021

Advances in Orthopedics

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Musculoskeletal corticosteroid injection is commonly used as an adjunct to help patients in pain management. In this current COVID-19 pandemic, many clinicians would differ from this treatment as steroid is considered an immunosuppressive drug and could risk the patient of developing severe adverse effects if contracting COVID-19. This is a retrospective study based in Sabah, Malaysia, examining the prevalence of COVID-19 infection following musculoskeletal corticosteroid injection from 1 December 2019 until 30 June 2020 in the sports medicine clinic and the orthopedic clinic. Patients who received musculoskeletal corticosteroid injection were called by telephone and asked about visits to the emergency department or government health clinic for influenza-like illness symptoms or severe acute respiratory infection that would require screening of COVID-19. Thirty-five patients who responded to the call were included, with mean ages of 47.9 years ± 15.1. 52% were male respondents, while 48% were female. 25% of them were diabetics, and 2.9% of them had a history of lymphoproliferative disorders. The mean pain score before injection was 6.74 ± 1.03 and after injection pain was 2.27 ± 1.63. In this study, there were 11.4% (n = 4) with minor complications of steroid injection, that is, skin discoloration. Nonetheless, there were no severe complications due to corticosteroids reported. There were no reported cases of COVID-19 among the respondents following corticosteroid injection. Musculoskeletal pain would affect a person’s well-being and activities; thus, its management requires that careful consideration with risk-benefit analysis be made before administering musculoskeletal corticosteroid injection during COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe?

Aziz

Hanifah

Nahar

2021

Advances in Orthopedics

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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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The systemic immunosuppressive effects of peripheral corticosteroid injections: A narrative review of the evidence in the context of COVID‐19

Regan

Elkhalifa

Barratt

2021

Musculoskeletal Care

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Introduction Injected glucocorticoid's (corticosteroids) are commonly used in musculoskeletal practice. The current global COVID‐19 pandemic has increased attention on the potential for locally injected corticosteroids to exert a systemic immunosuppressive effect and the implications this may have in relation to COVID‐19 infection and vaccination. Aim This narrative review summarises the evidence regarding the potential systemic immunosuppressive effects of peripheral corticosteroid injections in relation to the ongoing COVID‐19 pandemic. Method A narrative review was selected to allow inclusion of evidence related to a diverse range of topics relevant to this subject in order to provide the most comprehensive and clinically relevant guidance for clinicians. Results/discussion Current evidence demonstrates that cytotoxic, phagocytic and antigen presenting cells involved in both the innate and adaptive immune responses are suppressed for 48 h post‐injection and messenger cytokines that are integral to immune function are suppressed for over 96 h post‐injection. This potentially reduces an individual's ability to prevent viral infection, limit early viral replication, and delays activation of adaptive immune mechanisms (T and B lymphocytes) and subsequent viral clearance and elimination. The hypothalamic–pituitary–adrenal (HPA) axis can be suppressed for 2–4 weeks or longer following peripheral corticosteroid injections. The role of the HPA axis in immune function is not fully understood, however this could potentially indicate longer lasting immunosuppression. Conclusions This review found evidence of suppression of immune cell numbers for the first 48 h post‐injection, cytokines for over 96 h post‐injection and HPA axis suppression lasting for 2–4 weeks or longer. There is currently no evidence that these physiological changes translate into a clinically meaningful increased risk of COVID‐19 infection or related morbidity or mortality, but there is also no persuasive evidence that they do not. This review discusses the implications of the current evidence in relation to shared decision making, informed consent, risk management and COVID‐19 vaccination to provide clinicians with a pragmatic guide to help navigate the current uncertainty regarding the potential immunosuppressive effects of peripheral corticosteroid injections.

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Symptomatic COVID-19 infections in outpatient image-guided corticosteroid injection patients during the lockdown phase

Cited by 11 publications

References 26 publications

Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe?

Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe?

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

The systemic immunosuppressive effects of peripheral corticosteroid injections: A narrative review of the evidence in the context of COVID‐19

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