COVID-19 and Corticosteroid Joint Injections: Position Statements and Guidance

GUIDANCE: Clinical guide for the management of patients with musculoskeletal and rheumatic conditions on corticosteroids during the coronavirus pandemic
PUBLISHED BY:
NHS
PUBLICATION DATE: 25th March 2020
SUMMARY:

  • Consider alternatives to steroid where possible.
  • Only give steroid for severe symptoms and where there are no other options.
  • Consider if using another treatment option presents less risk at this time but can give similar benefit.
  • The potential risk (of corticosteroid) needs particular consideration in vulnerable patient groups.
  • Ensure patients are fully aware of the potential increased risk. They must be engaged in decision making.
  • This guidance applies to all adults regardless of age.

REFERENCE: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/CO0043_Specialty-guide-and-coronavirus_-MSK-corcosteroid_-v1-25March.pdf  
 



GUIDANCE: FPM response to concern related to the safety of steroids injected as part of pain procedures during the current COVID-19 virus pandemic
PUBLISHED BY:
Faculty of Pain Medicine of the Royal College of Anaesthetists
PUBLICATION DATE: 17th March 2020
SUMMARY:

  • Caution should be used when assessing patients for steroid injections balancing the severity of underlying disease, the potential benefit and the risks including immunocompromise, underlying comorbidities and further risk should the patient have or become infected in the period after injection when there is likely to be an ongoing effect on the immunological system.
  • Patients should be fully aware of the potential increased risk, the lack of clear evidence and be engaged in decision making. Likewise, individual units should consider the risk and benefits of such injections and under which circumstances they will continue using them during the current clinical conditions.

REFERENCE: https://fpm.ac.uk/sites/fpm/files/documents/2020-03/FPM-COVID-19-Steroid-Statement-2020.pdf  
 



GUIDANCE: Coronavirus: College of Podiatry and Royal College of Physicians and Surgeons of Glasgow guidance on steroid injections
PUBLISHED BY:
College of Podiatry and Royal College of Physicians and Surgeons of Glasgow
PUBLICATION DATE: March 2020
SUMMARY:

  • The College of Podiatry and the Faculty of Podiatric Medicine of the Royal College of Physicians and Surgeons of Glasgow jointly recommend, on the balance of current evidence and risk, that podiatrists should avoid the use of corticosteroid injections and to seek to employ clinical alternatives, such as delaying administration of the injection or sodium hyaluronate, wherever possible.

REFERENCE: https://cop.org.uk/news/coronavirus-college-of-podiatry-and-royal-college-of-physicians-and-surgeons-of-glasgow-guidance-on-steroid-injections/
 

Dr Nat Padhiar’s position, who originally wrote much of the guidance with the College of Podiatry:

1.THERE IS CONCERN REGARDING STEROID USE AND IMMUNOSUPPRESSION DURING THIS UNCERTAIN COVID-19 PANDEMIC.
2.THERE IS NO REAL EVIDENCE AT THIS STAGE REGARDING THIS CONCERN BUT OPINIONS, REPORTS ETC IS CHANGING ON A DAILY BASIS. 
3.THERE ARE VARIOUS ALTERNATIVES, WHICH IN MANY RESPECT ARE BETTER WITHOUT COMPROMISING IMMUNE RESPONSE.e.g. PROLOTHERAPY, HYALURONIC ACID & PRP. 
4.EXERCISE CAUTION AND USE ALTERNATIVES UNTIL WE GET A CLEARER PICTURE OF INJECTABLE STEROID & COVID-19. 
5. WEIGH UP RISK:BENEFIT RATIO. CURRENT ADVICE IS TO ONLY CONSIDER USING IT FOR ACUTE CONDITIONS e.g. GOUT.
6. IF YOU HAD TO USE IT ON A PATIENT, ENSURE THEY ARE FULLY INFORM CONSENTED. ALSO MAKE SURE STEPS ARE TAKEN TO SCREEN THEM FOR COVID-19. A SIMPLE QUESTIONNAIRE AND TEMPERATURE. 

•    Nat Padhiar: "Access these guidelines from FPM, I like their point 4, think of MDT approach if you had to use steroid. file:///C:/Users/Nat/Downloads/FPM-BPS-Guidance-on-Pain-Interventions-COVID-June-2020%20(1).pdf Also think of alternatives e.g. Ostenil products are good for both joints and tendons. Then there is prolotherapy and PRP, even though latter requires a centrifuge and ability to take blood."

Dr Nat Padhiar MSc PhD CSci FCPodS (Lond) FHEA FFPM RCPS(Glas)
Consultant Podiatric Surgeon, Chartered Scientist & Honorary Reader 
Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary, University of London.

 



GUIDANCE: The safety of corticosteroid injections during the COVID-19 global pandemic
PUBLISHED BY:
British Society of Skeletal Radiologists
PUBLICATION DATE: 19th March 2020
SUMMARY:

  • Intra-articular steroid injections should be avoided, whenever possible during the COVID-19 pandemic to reduce the risk of reduced immunity to viral exposure.
  • Alternative non-steroid pain injections or interventions may still be carried out.

REFERENCE: https://www.bssr.org.uk/static/uploads/forum/Musculoskeletal_Radiology_during_the_COVID-19_Global_Pandemic.pdf

 



GUIDANCE: NSAIDs and corticosteroid injections during the COVID pandemic: what Sport and Exercise Medicine Physicians (and sports physios) should know
PUBLISHED BY:
British Journal of Sports Medicine (via a blog by Professor Jane Fitzpatrick)
PUBLICATION DATE: 21st March 2020
SUMMARY:

  • If there is a need for a corticosteroid injection, consider the use of betamethasone, other management options or defer the injection until the risk associated with the coronavirus pandemic is reduced.

REFERENCE: https://blogs.bmj.com/bjsm/2020/03/21/nsaids-and-corticosteroid-injections-during-the-covid-pandemic-what-sport-and-exercise-medicine-physicians-and-sports-physios-should-know/