Relationship of Imaging-guided Corticosteroid Injections to COVID-19 Incidence in the Pandemic Recovery Period.

Abstract

BackgroundCorticosteroids injected for the treatment of musculoskeletal pain are systemically absorbed and can affect the immune response to viral infections.PurposeTo determine the incidence of symptomatic COVID-19 disease in individuals receiving image-guided corticosteroid injections for musculoskeletal pain compared with the general population during the pandemic recovery period.Materials and methodsIn this prospective cohort multicenter study, adults with a history of musculoskeletal pain who underwent imaging-guided intra-articular and spine corticosteroid injections between April 2020 and February 2021 were consecutively enrolled. Participants were followed for a minimum of 28 days through their electronic medical record (EMR) or by direct phone call to screen for COVID-19 test results or symptoms. Clinical data including body mass index (BMI) was also obtained from the EMR. Incidence of COVID-19 in the state was obtained using the Massachusetts COVID-19 Response Reporting website. Student t tests were used for continuous variable comparisons. Univariable analyses were performed using Fisher exact tests.ResultsA total of 2714 corticosteroid injections were performed for 2190 adult participants (mean age ± standard deviation, 59 ± 15 years, 1031 women). Follow-up was available for 1960 (89%) participants who received 2484 injections. Follow-up occurred 97 ± 33 days (range 28 – 141 days) after the injection. There were 10/1960 participants with COVID-19 within 28 days from the injection (0.5%, 95% CI, 0.24-0.94%) and 43/1960 participants with COVID-19 up to 4 months after the injection (2.2% 95%CI, 1.6-2.9%). This was lower than the incidence rate in the population of Massachusetts during the same period (519,195/6,892,503, 7.5%, P <.001 both at 28 days and 4 months). Participants diagnosed with COVID-19 (n=10) at 28 days had higher BMI than the entire cohort (n=1960) (32 ± 10 vs. 28 ± 6 kg/m2, P=.04).ConclusionAdults who received image-guided corticosteroid injections for pain management performed during the pandemic recovery period had a lower incidence of symptomatic COVID- 19 compared with the general population.