Joint injections during the COVID pandemic

Due to the current pandemic with COVID-19 the guidance from the British society of Rheumatology states clearly that a steroid joint injection should only be considered when the benefit outweighs the risk. The most common reason is severe debilitating pain that does not respond to medication or rubs, interferes with sleep and is getting worse despite other treatments.

The British Society of Rheumatology have recently updated their guidance which you can read here.

Guidelines vary between countries, but as with any cortisone injection either into a joint, tendon area or muscle, the potential risks and benefits should always be carefully considered.

The guidance has recently been updated as restrictions in all ares of social life are eased.

So what are the risks of having a steroid joint injection or a steroid injection into the muscle?

It is well known that the steroids whether taken by mouth or by an injection into the muscle can potentially lower the immune system’s response to infection. This is usually related to the dose given.

So anything above a dose of 7 mg of prednisolone ( a common oral steroid) means that your immune system will be subdued or suppressed at responding to any type of infection- viral, bacterial or even fungal.

Like everything in the human body, some people respond differently to different doses of steroid and so teh lowest possible dose should always be used.

Suppressing ones immune system means increasing your risk of infection or your ability to deal with infection if you get it.

A recent study from China documented that patients who developed COVID-19 took longer to clear the virus but did not have an increase din mortality.

So when can I have a steroid joint injection or soft tissue injections for musculoskeletal pain ?

Musculoskeletal pain is experienced in osteoarthritis, shoulder pain, knee pain, elbow pain and outer hip pain,

The current recommendations before joint injections are simple analgesia, modifying ones activities to ease pain, splinting where appropriate and exercise to strengthen and increase the stability of the joint or tendon.

Steroid injection should only be considered if a patient is experiencing high levels of pain and disability- such as poor sleep- and has has failed first-line measures and ongoing symptoms have a significant negative effect on their health and wellbeing.

Patients should always be consented to explain the risks and benefits and the doctor should carefully consider the dose of steroid used, choosing the lowest dose. each time.

Also, post injection care is so important and exercise forms the foundation of any recovery from joint pains. So, patients should always be given guidance on exercise therapy and minimising their risk of infection by maintaining social distancing and hand washing habits for the following 2-3 months.