During these challenging times ACPOMIT will endeavour to support injecting Physiotherapists by reviewing and posting the literature relating to use of corticosteroid injections during the COVID-19 pandemic.
Patients who receive a steroid injection during the COVID-19 pandemic may be at increase the risk of an adverse outcome, and this is especially true for vulnerable patient groups including but not limited to patients over the age of 70, and those with diabetes, ischaemic heart disease, chronic respiratory disease and hypertension.
The World health organisation recommend that systemic corticosteroids should be avoided in patients with COVID-19 unless indicated for another reason. This is because there is evidence from a early study of patients in Wuhan that corticosteroids may cause delayed COVID-19 viral clearance. Furthermore, corticosteroids have been associated with an increased risk for mortality in patients with influenza and delayed viral clearance in patients with Middle East respiratory syndrome.
NHS england offer a comprehensive guide on the suitability of steroids in Rheumatic and MSK conditions. The document is supported by the Chartered Society of Physiotherapy (CSP), British Association of Orthopaedics (BOA), British Association of Spinal Surgeons (BASS) and the British Society for Rheumatology (BSR). The British society of skeletal radiologists, Faculty of pain medicine, British and the college of Podiatry have also published recommendations.
The above publications recommended a cautious approach to offering corticosteroid injection during the pandemic, but at times their guidance has been interpreted as ceasing this therapy all together. Bone and Joint published the below article which endeavours to evaluate the degree of risk in more detail, and offer guidance that with careful patient section, in all probability, the risk is likely very low, and that the use of corticosteroid injection should continue for many patients.