Corticosteroid injections during the COVID-19 pandemic

Abstract

Aims To describe the incidence of adverse clinical outcomes related to COVID-19 infection following corticosteroid injections (CSI) during the COVID-19 pandemic. To describe the incidence of positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) testing, positive SARS-COV2 IgG antibody testing or positive imaging findings following CSI at our institution during the COVID-19 pandemic. Methods A retrospective observational study was undertaken of consecutive patients who had CSI in our local hospitals between 1 February and 30June 2020. Electronic patient medical records (EPR) and radiology information system (RIS) database were reviewed. SARS-CoV-2 RT-PCR testing, SARS-COV2 IgG antibody testing, radiological investigations, patient management, and clinical outcomes were recorded. Lung findings were categorized according to the British Society of Thoracic Imaging (BSTI) guidelines. Reference was made to the incidence of lab-confirmed COVID-19 cases in our region. Results Overall, 1,656 lab-confirmed COVID-19 cases were identified in our upper tier local authority (UTLA), a rate of 306.6 per 100,000, as of 30June 2020. A total of 504 CSI injections were performed on 443 patients between 1 February and 30June 2020. A total of 11 RT-PCR tests were performed on nine patients (2% of those who had CSI), all of which were negative for SARS-CoV-2 RNA, and five patients (1.1%) received an SARS-CoV-2 IgG antibody test, of which 2 (0.5%) were positive consistent with prior COVID-19 infection, however both patients were asymptomatic. Seven patients (1.6%) had radiological investigations for respiratory symptoms. One patient with indeterminate ground glass change was identified. Conclusion The incidence of positive COVID-19 infection following corticosteroid injections was very low in our cohort and no adverse clinical outcomes related to COVID-19 infection following CSI were identified. Our findings are consistent with CSI likely being low risk during the COVID-19 pandemic. The results of this small observational study are supportive of the current multi-society guidelines regarding the judicious use of CSI. Cite this article: Bone Joint Open 2020;1-9:605–611.

Hypersensitivity reaction to Hyaluronic Acid Dermal filler following novel Coronavirus infection – a case report

“…However, short‐term or low‐dose steroids such as is indicated for delayed‐type hypersensitivity can be safely used 37 . In patients without a known positive test result for SARS‐CoV‐2, there appears to be no increased risk of contracting the virus even in the presence of comorbidities for which steroids are frequently used 38,39 …”

“…37 In patients without a known positive test result for SARS-CoV-2, there appears to be no increased risk of contracting the virus even in the presence of comorbidities for which steroids are frequently used. 38,39 The patient in this report had already recovered from confirmed SARS-CoV-2 infection, and as such treatment with steroid would be appropriate in any case had she required its use.…”

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

“…A larger study with 504 steroid injections had a 2.7% rate of infection, of which 1.1% were asymptomatic. There were no severe adverse outcomes to COVID-19 infection reported in the study [ 14 ]. Compared to our study, where we have zero infection rates, the rate of infection of COVID-19 is still low with no severe adverse outcomes following steroid injection.…”

“…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 ]. We hypothesize that there will be a very low risk of developing COVID-19 infection following musculoskeletal steroid injection.…”

Musculoskeletal steroid injections during the COVID-19 pandemic

“…Corticosteroid injections are routinely used for the localised management of a broad range of painful musculoskeletal conditions, with the knee and shoulder being the two most common areas injected. 1 , 2 , 3 The injection is predominantly given to patients suffering from joint arthritis, bursitis, tendinopathy, and synovitis. 1 , 2 The objective is to control pain, improve the quality of activities of daily living, increase range of motion, and in some instances it may also delay or prevent surgery.…”