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      Are foot and ankle corticosteroid injections safe during the COVID-19 pandemic? A single center prospective observational study

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          Abstract

          Background

          Intra-articular corticosteroid injections (ICSI) are commonly used in orthopaedic practice. Due to concerns about their immunosuppressive effects, we conducted a prospective observational audit, to monitor for COVID-19 infection amongst a group of foot and ankle patients who received an ICSI during the pandemic.

          Patients and methods

          Included were 68 patients (25 males - 43 females, mean age 59.1 years, SD 15.0, range 19 – 90 years) who received a fluoroscopy-guided ICSI within a two-month period during the pandemic. The American Society of Anaesthesiologists (ASA) grade was I in 35% of patients, II in 58% and III in 7%. 16% of patients had black, Asian or minority ethnic (BAME) background. The dose of methylprednisolone injected was 20 mg for 28% of the patients, 40 mg for 29% and 80 mg for 43%.

          Results

          All patients were available for follow up at one and four weeks post-injection. None reported COVID-19 infection symptoms within this period. The only complication was a flare-up of joint pain.

          Conclusion

          Our study showed that the risk of COVID-19 infection to patients receiving foot or ankle ICSI is low. The limitations of this work must be considered, but our findings support the judicious use of corticosteroid injections during the current crisis

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          Most cited references19

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          Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

          Mark Peters (2020)
          Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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            Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome

            Yaseen M. Arabi, Yasser Mandourah, Fahad M. Al-Hameed … (2018)
            Corticosteroid therapy is commonly used among critically ill patients with Middle East Respiratory Syndrome (MERS), but its impact on outcomes is uncertain. Analyses of observational studies often do not account for patients' clinical condition at the time of corticosteroid therapy initiation.
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              Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients

              Nelson Lee, K.C Allen Chan, David S. C. Hui … (2004)
              Background: The effect of corticosteroid treatment on the viral load of Severe Acute Respiratory Syndrome (SARS) patients is unknown. Objective: To compare the plasma SARS-CoV RNA concentrations in ribavirin-treated patients who received early hydrocortisone therapy with those who received placebo. Study design: Serial plasma SARS-CoV RNA concentrations measured in the setting of a prospective, randomized double-blinded, placebo-controlled trial designed to assess the efficacy of “early” (<7 days of illness) hydrocortisone use in previously healthy SARS patients were analyzed. SARS-CoV RNA was quantified using a one-step real-time RT-PCR assay targeting the nucleocapsid gene. Results: Among 16 non-ICU cases, SARS-CoV RNA was detected in plasma since day 3–4 after fever onset; viral concentration peaked in the first week, which then rapidly declined in the second week of illness. On days 8, 12, 16, and 20, the cumulative proportion of patients with undetectable virus in plasma was 31%, 69%, 92%, and 100%, respectively. Plasma SARS-CoV RNA concentrations in the second and third week of illness were significantly higher in patients who received initial hydrocortisone treatment (n = 9), as compared to those who received placebo (n = 7)(AUC; Mann–Whitney, P = 0.023). The median time for SARS-CoV to become undetectable in plasma was 12 days (11–20 days) versus 8 days (8–15 days), respectively. Conclusion: Our findings suggested “early” corticosteroid treatment was associated with a higher subsequent plasma viral load.
              Article 0 comments Cited 175 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Foot (Edinb)
                Journal ID (iso-abbrev): Foot (Edinb)
                Title: Foot (Edinburgh, Scotland)
                Publisher: The Authors. Published by Elsevier Ltd.
                ISSN (Print): 0958-2592
                ISSN (Electronic): 1532-2963
                Publication date PMC-release: 15 March 2023
                Publication date (Electronic): 15 March 2023
                Electronic Location Identifier: 102001
                Affiliations
                [a ]Epsom and St Helier
                [b ]St George’s University of London
                Author notes
                [* ]Corresponding author.
                [1]

                Royal National Orthopaedic Hospital Stanmore

                Article
                Publisher Item ID: S0958-2592(23)00042-1 Publisher ID: 102001
                DOI: 10.1016/j.foot.2023.102001
                PMC ID: 10014129
                SO-VID: 4f37e789-89c6-4b90-a502-99a8f67c6aa7
                Copyright © © 2023 The Authors. Published by Elsevier Ltd.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 12 June 2022
                Date accepted : 5 March 2023
                Categories
                Subject: Article

                Keywords: foot and ankle,corticosteroid injections, covid-19
                Data availability:
                Keywords: foot and ankle, corticosteroid injections, covid-19

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