Musculoskeletal corticosteroid injections were used safely in patients during the COVID-19 pandemic

Abstract

Objectives: Studies have highlighted that corticosteroid use can cause immunocompromise. During the COVID-19 pandemic, caution was advised on corticosteroid injections (CSIs) use and the possibility of increasing patients’ susceptibility to COVID-19. CSI is commonly used to manage pain, which is increasingly important with prolonged waiting lists. This study aimed to assess the occurrence of COVID-19 infection following the administration of CSI for musculoskeletal pain. Methods: A prospective cohort study of patients receiving CSI for musculoskeletal conditions through the COVID-19 pandemic was followed. It monitored post-injection through clinical review and telephone follow-up as to whether they were diagnosed with COVID-19 or had its symptoms. Patients were administered either half or full-dose corticosteroids as per guidance at the time. Patients were followed up at 8 weeks, 3 and 6 months. Results: One hundred and ninety-six patients were included (100 males and 96 females). One hundred and fourteen patients received 40 mg of Depo-Medrone, and 90 received 20 mg of Depo-Medrone. No patients suffered COVID-19 symptoms or had positive viral polymerase chain reaction (PCR) tests by 3-month follow-up. By the 6-month follow-up, four of the cohort had mild symptoms and a positive PCR test for COVID-19. None required hospitalization. Conclusion: Our study demonstrated only a 2% incidence of COVID-19 infection following the administration of CSI for musculoskeletal pain within the 6-month follow-up, despite a high local prevalence for infection. We observed no correlation between CSI and COVID-19 acquisition and noted no clear increase in risk. We would therefore endorse CSI use if required for patients after careful patient selection and shared decision-making.