From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114 (J.R.T.V., S.H., F.J.S., A.B.K., A.R.G., M.A.B., C.Y.C.); and Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Mass (S.J.S.).
Radiology. 2023 Jan;306(1):237-243. doi: 10.1148/radiol.220271. Epub 2022 Jul 5.
Background Corticosteroids injected for the treatment of musculoskeletal pain are systemically absorbed and can affect the immune response to viral infections. Purpose To 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 Methods In this prospective cohort multicenter study, adults with a history of musculoskeletal pain who underwent imaging-guided intra-articular and spine corticosteroid injections from April 2020 to February 2021 were consecutively enrolled. Participants were followed for a minimum of 28 days through their electronic medical record (EMR) or by direct phone communication to screen for COVID-19 test results or symptoms. Clinical data, including body mass index (BMI), were also obtained from the EMR. The incidence of COVID-19 in the state was obtained using the Massachusetts COVID-19 Response Reporting website. The Student test was used for continuous variable comparisons. Univariable analyses were performed using the Fisher exact test. Results A total of 2714 corticosteroid injections were performed in 2190 adult participants (mean age, 59 years ± 15 [SD]; 1031 women). Follow-up was available for 1960 participants (89%) who received 2484 injections. Follow-up occurred a mean of 97 days ± 33 (range, 28-141 days) after the injection. Of the 1960 participants, 10 had COVID-19 within 28 days from the injection (0.5% [95% CI: 0.24, 0.94]) and 43 had COVID-19 up to 4 months after the injection (2.2% [95% CI: 1.6, 2.9]). These incidence rates were lower than that of the population of Massachusetts during the same period (519 195 of 6 892 503 [7.5%], < .001 for both 28 days and 4 months). Participants diagnosed with COVID-19 ( = 10) within 28 days from the injection had a higher BMI than the entire cohort ( = 1960) (mean, 32 kg/m ± 10 vs 28 kg/m ± 6; = .04). Conclusion Adults who received image-guided corticosteroid injections for pain management during the pandemic recovery period had a lower incidence of symptomatic COVID-19 compared with the general population. © RSNA, 2022
背景 用于治疗肌肉骨骼疼痛的皮质类固醇注射会被全身吸收，并可能影响对病毒感染的免疫反应。目的 确定在大流行恢复期接受影像学引导下皮质类固醇注射治疗肌肉骨骼疼痛的个体与普通人群相比，出现有症状 COVID-19 疾病的发生率。
材料与方法 在这项前瞻性队列多中心研究中，连续纳入 2020 年 4 月至 2021 年 2 月期间因肌肉骨骼疼痛接受影像学引导下关节内和脊柱皮质类固醇注射的成年患者。通过电子病历（EMR）或直接电话联系对参与者进行至少 28 天的随访，以筛查 COVID-19 检测结果或症状。还从 EMR 中获取临床数据，包括体重指数（BMI）。通过马萨诸塞州 COVID-19 反应报告网站获取该州 COVID-19 的发生率。使用 Student 检验进行连续变量比较。使用 Fisher 确切检验进行单变量分析。
结果 在 2190 名接受皮质类固醇注射的成年参与者（平均年龄，59 岁±15[SD]；1031 名女性）中，共进行了 2714 次皮质类固醇注射。1960 名参与者（89%）可获得随访，共接受了 2484 次注射。在注射后平均 97 天±33（范围，28-141 天）时进行随访。在 1960 名参与者中，有 10 名在注射后 28 天内发生 COVID-19（0.5%[95%CI：0.24，0.94]），有 43 名在注射后 4 个月内发生 COVID-19（2.2%[95%CI：1.6，2.9]）。这些发病率低于同期马萨诸塞州的人群（519 195 例/6 892 503 例[7.5%]，两者均<.001）。在注射后 28 天内被诊断为 COVID-19（n=10）的参与者的 BMI 高于整个队列（n=1960）（均值，32 kg/m±10 比 28 kg/m±6；=.04）。
结论 在大流行恢复期接受影像学引导下皮质类固醇注射治疗疼痛的成年人与普通人群相比，出现有症状 COVID-19 的发病率较低。
