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 greater risk of contracting, transmitting, or becoming severely unwell with COVID-19.
In the early stages of the pandemic the World Health Organisation recommend that systemic corticosteroids should be avoided in patients with COVID-19 unless indicated for another reason. Over time this guidance has changed, and corticosteroids, specifically dexamethasone, has become a key treatment for ventilated and non-ventilated patients. Similarly, routine corticosteroid injections for MSK conditions were paused at the start of the pandemic due to unknowns around increased risk. Overtime, with the benefit of national publications the consensus has changed to one of shared decision making.
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. These documents are listed below:
BSSR The safety of corticosteroid injections during the COVID-19 global pandemic
FPM response to concern related to the safety of steroids injected as part of pain procedures during the current COVID 19 virus pan demic
NHS England Clinical guide for the management of patients with musculoskeletal and rheumatic conditions on corticosteroids during the coronavirus pandemic
Joint response of the College of Podiatry and the Faculty of Podiatric Medicine of the Royal College of Physicians and Surgeons of Glasgow: Guidance on the safety of steroids injected as part of podiatric procedures during the current COVID-19 virus pande
The cautious approach recommended in the above is largely supported in the retrospective observational study published by Bone and Joint Journal below. They investigated the risk of contracting COVID-19 after receiving a corticosteroid injection. The authors found that the incidence of positive COVID-19 infection following corticosteroid injections was very low, and there were no adverse clinical outcomes related to COVID-19 infection following corticosteroid injection.
corticosteroid injections during the COVID-19 pandemic
At present, in January 2021 it appears that with careful patient section, in all probability, the risk is likely very low. However an individualized, judicious approach should continue until more evidence exists. Patients individual risks, their preferences and the expected benefits of a corticosteroid injection should be considered in order to make a shared decision about the appropriateness of a corticosteroid injection.