Caution during Coronavirus pandemic
Steroid injections are commonly used to treat painful musculoskeletal conditions affecting joints and tendons. Steroid injections can relieve pain, improve mobility, facilitate physiotherapy and may also help avoid or delay the need for surgery. Small amounts of the steroid preparations used for joint injections get absorbed into the bloodstream and may cause a brief and small suppressive effect on the immune system. Whilst this may not generally affect the health of the individual it may pose risks if the individual were to get COVID-19. Unfortunately these effects are poorly understood because of the novel nature of the infection and the lack of research into it.
COVID-19 is a new disease caused by the novel Coronavirus known as SARS-CoV2. It may take some days for symptoms to develop after an individual catches the infection. Most individuals who catch the virus experience either no symptoms or only mild symptoms such as fever and cough. However some individuals suffer more severe symptoms such as breathing difficulty that may lead to admission to hospital, treatment in an intensive care unit or even death. It is recognised that some clinically vulnerable or extremely vulnerable individuals are more likely to get seriously ill with a Coronavirus infection.
There is a possibility that if a steroid injection was administered to an asymptomatic individual who is carrying the Coronavirus or to an individual who catches the virus soon after the injection, they are potentially at risk of becoming seriously ill. This potential risk needs to be balanced against the benefits before considering an injection, particularly in individuals who are clinically vulnerable, such as those over the age of 70 years, with diabetes, severe obesity, heart or lung conditions, chronic kidney or liver disease or those who are immunocompromised.
Current national guidance recommends that patients with musculoskeletal pain should initially be offered simple analgesia, activity modification, splinting where appropriate and exercise as first line treatment. Steroid injection should only be considered –
- if a patient has high levels of pain and disability and has failed first-line measures
- if continuation of those symptoms will have a significant negative effect on their health and wellbeing and
- after obtaining informed consent.
A patient information leaflet regarding steroid injection in the hand or upper limb during the COVID-19 pandemic from the BOA, BSSH and BESS can be viewed here.
What precautions should patients take when considering a steroid injection?
If you are planning to have a steroid injection you should take special precautions to avoid catching the Coronavirus infection by –
- exercising social distancing
- frequent hand washing
- self-isolating or shielding at home for two weeks before and two weeks after the injection.
You should not have the injection if you or anyone in your household have experienced symptoms such as fever, cough, sore throat, shortness of breath or loss of taste or smell in the fourteen days preceding an injection.
Steroid injections and the Coronavirus vaccine
If you have a steroid injection shortly before or soon after the Coronavirus vaccine, you may not mount a good immune response to the vaccine. It is recommended that you should avoid having a steroid injection two weeks before or after the vaccine.
What is being injected?
The injection consists of two medications: a steroid (usually Depomedrone) and a local anaesthetic numbing agent (Lignocaine and/or Marcaine).
What should I do afterwards?
It is recommended that you should avoid any strenuous activities for approximately 48 hours. Appointments for physiotherapy should be deferred for at least 3-4 days.
What are the side-effects ?
Vaso-vagal syncope: Some patients may feel faint after an injection. If this happens, you will be asked to lie down for a short while to recover.
Steroid Flare-up: There is a possibility of an increase in pain for 24 hours after the injection. This is called a 'steroid flare'. You may wish to pre-emptively take some pain-relieving tablets for a day or two after the injection. The pain will usually ease on its own. You should rest the affected joint and apply ice to the area.
Infection: There is a small chance of infection (less than 1 in 2000). If you notice any of these signs or symptoms -redness, increased warmth, drainage or fever over 37.5 degrees Celcius you should contact the hospital for advice.
Skin discoloration: Individuals with dark complexions may experience some skin discoloration locally at the site of the injection some time later.
Changes in blood sugar: Individuals with diabetes may experience an increase in blood sugar levels for a day or two after a steroid injection and should monitor these levels closely.
Do I need to be seen again?
You will be advised to make an outpatient appointment to see your consultant 6-8 weeks after receiving the injection.