JOINT INJECTIONS
DURING COVID
Important information regarding your injection during COVID
Dear Patient,
If you are reading this, you may well be considering having a steroid injection.
Corticosteroids can cause immunosuppression (weaken the immune system). Injections are given directly to the site of pain or inflammation, to reduce these systemic (whole body) effects of the drug. Some small systemic effects are common though. We know that steroids have been proven to worsen viral infections and prolong viral illness.
It is possible therefore that following a steroid injection you may be more prone to contracting COVID-19 if exposed to it and your illness may be more severe or more prolonged.
During the COVID-19 pandemic the NHS has recommended practitioners only consider corticosteroid injection if patient has….”high levels of pain and disability, has failed first-line measures and continuation of those symptoms will have a significant negative effect on their health and wellbeing and after obtaining informed consent”.
Everyone is different. We need to balance benefits and risks and you need to be clear and informed about the risks in your individual situation.
We know certain groups of patients are already at risk of becoming unwell if they contract COVID-19. These are detailed below and you should be clear which group you sit in.
The level of detected COVID-19 infection circulating in the region is also a factor to consider as this gives us an idea of the likelihood of coming into contact with the disease in the community. Information on circulating levels of COVID-19 infection in regions can be found here. Please be aware this report is predominantly of symptomatic detected cases and many cases are asymptomatic.
https://www.mrc-bsu.cam.ac.uk/now-casting/
What risk category am I in?
COVID-19 risk catergories
People at high risk (clinically extremely vulnerable)
People at high risk from coronavirus include people who:
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have had an organ transplant
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are having chemotherapy or antibody treatment for cancer, including immunotherapy
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are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
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are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
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have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
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have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
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have been told by a doctor they have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
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have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
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are taking medicine that makes them much more likely to get infections (such as high doses of steroids or immunosuppressant medicine)
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have a serious heart condition and are pregnant
People at moderate risk (clinically vulnerable)
People at moderate risk from coronavirus include people who:
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are 70 or older
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have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
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have heart disease (such as heart failure)
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have diabetes
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have chronic kidney disease
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have liver disease (such as hepatitis)
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have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
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have a condition that means they have a high risk of getting infections
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are taking medicine that can affect the immune system (such as low doses of steroids)
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are very obese (a BMI of 40 or above)
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are pregnant
People at lower risk (normal vulnerability)
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under 70
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no co-morbidities
Other considerations:
BAME (Black, Asian and Minority Ethic) populations may be at increased risk also
References:
Management of patients with musculoskeletal and rheumatic conditions who:
-are on corticosteroids,require initiation of oral/IV corticosteroids or require a corticosteroid injection
16 June 2020
Coronavirus (COVID-19): Shielded patients list
NHS Digital has published the shielded patients list (SPL), which is enabling partner organisations across government to support and protect those who need shielding at this time.
https://digital.nhs.uk/coronavirus/shielded-patient-list
Public health England Disparities in the risk and outcomes of COVID-19
2nd June 2020
