COVID 19 and steroid injections

We would like to make patients aware of the use of Corticosteroids in relation to COVID 19.

Steroids suppress the imune system

We will be discussing the possible impact of COVID 19 on steroid injections. Steroids are a potent anti-inflammatory which is why they have such a significant impact on levels of pain.

Steroids suppress the immune system

One way in which steroids affect inflammation is by a by supressing it. As the immune system plays a major role in your body’s ability to fight infections steroids will therefore also potentially affect your body’s ability to fight infections. There is very little research or data to guide on this matter in terms of the exact increase in risk. It is important that any patients considering a corticosteroid injection are aware of the fact that corticosteroids could theoretically i) increase the likelihood of contracting COVID-19 due to its immuno-suppressant effect ii) inhibit their body’s ability to fight the COVID-19 virus if contracted and iii) could potentially make the patients more contagious to people around them, following a corticosteroid injection.

Evidence

One study published in 2018 showed patients who had received a corticosteroid injection were more likely to develop seasonal flu.  For these reasons we are screening all patients with regards to following criteria:

  • Do you currently have symptoms of COVID-19 or have you recently been in contact with a person with symptoms
  • Are you in a high risk group for COVID-19 and / or do you live with a person in a high risk group (patients over the age of 70, and those with diabetes, ischaemic heart disease, chronic respiratory disease or hypertension)
  • Patients must be referred or directly recommended for corticosteroid injection by their GP
  • Patients must confirm that they are aware of and have considered the additional COVID-19 risks in relation to the immuno-suppressant effect
  • Patients must confirm that alternative treatments have been discussed and / or trialled
  • Patients must confirm that the risks and benefits of receiving a corticosteroid injection have been discussed with GP or other health care professional
  • Provide reasons to support that it would have significant detrimental impact on patients health (or health of person they care for) if corticosteroid injection were refused or delayed

Telephone screening

We are providing a telephone screening for any patients wishing to consider corticosteroid injections and we also consider against the following recommended criteria:

  • Patient has high levels of pain and disability
  • Patient has failed first-line treatment measures (e.g. analgesia, rest, splints, activity modification or exercise) and continuation of pain symptoms will have a significant negative effect on their health and wellbeing.
  • Patient is willing to integrate corticosteroid injection treatment with holistic rehabilitation e.g. activity modification and exercise therapy.
  • Would an alternative injection treatment be appropriate e.g hyaluronic acid

Consider travel arrangements

We also request all patients to consider and plan their travel arrangements to and from our clinic with respect to government guidelines and social distancing.  It is important that any patient considering a corticosteroid injection has weighed up the potential risks and benefits of receiving the injection and feel that delaying corticosteroid injection would have a derogatory effect on their health or the health of a person that they are a carer for.

Whilst acknowledging the potential risks of corticosteroid injections in relation to COVID-19 we are also aware of the extreme difficulties many patients are facing in relation to musculoskeletal pain and impact this has on their function as well as their physical and mental well-being during these challenging times.

Steps to minimise risks to our patients:

  • Additional screening including direct call to patients prior to any bookings
  • Additional COVID-19 specific section to our online consent form
  • Additional time between each patient booking to clean room and equipment and facilitate social distancing in waiting area
  • Use of lowest dose of steroid that is clinically appropriate

Factors putting you at a higher risk of COVID 19

People at high risk (clinically extremely vulnerable)

People at high risk from coronavirus include people who:

  • have had an organ transplant
  • are having chemotherapy or antibody treatment for cancer, including immunotherapy
  • are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
  • are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
  • have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
  • have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
  • have been told by a doctor they have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
  • have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
  • are taking medicine that makes them much more likely to get infections (such as high doses of steroids or immunosuppressant medicine)
  • have a serious heart condition and are pregnant

If you’re at high risk from coronavirus, you should have received a letter from the NHS.

Speak to your GP or hospital care team if you have not been contacted and think you should have been.

What to do if you’re at high risk

If you’re at high risk from coronavirus, you’re advised to take extra steps to protect yourself.

This is called shielding.

People at moderate risk (clinically vulnerable)

People at moderate risk from coronavirus include people who:

  • are 70 or older
  • are pregnant
  • have a lung condition that’s not severe (such as asthma, COPD, emphysema or bronchitis)
  • have heart disease (such as heart failure)
  • have diabetes
  • have chronic kidney disease
  • have liver disease (such as hepatitis)
  • have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy)
  • have a condition that means they have a high risk of getting infections
  • are taking medicine that can affect the immune system (such as low doses of steroids)
  • are very obese (a BMI of 40 or above)

What to do if you’re at moderate risk

If you’re at moderate risk from coronavirus, you can go out to work (if you cannot work from home) and for things like getting food or exercising. But you should try to stay at home as much as possible.

It’s very important you follow the general advice on social distancing, including staying at least 2 metres (3 steps) away from anyone you do not live with.

Unlike people at high risk, you will not get a letter from the NHS.