From the Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine (TTS, RGM, LSG), Division of Health Care Policy & Research, Department of Health Sciences Research (RGM), Division of Clinical Statistics (KMF), and Internal Medicine Residency (KRD), Mayo Clinic, Rochester, Minnesota.
Am J Phys Med Rehabil. 2023 Nov 1;102(11):953-958. doi: 10.1097/PHM.0000000000002236. Epub 2023 Mar 8.
Although intra-articular corticosteroid (IACS) is injected locally, some systemic absorption occurs, potentially causing immunosuppression in recipients. This study examined the odds of influenza in patients who received IACS compared with matched controls.
Adults in the authors' health system who received IACS from May 2012 through April 2018 were 1:1 matched to adults without IACS. The primary outcome was overall odds of influenza. Secondary analyses examined influenza odds by timing of IACS, joint size, and vaccination status.
A total of 23,368 adults (mean age, 63.5 yrs, 62.5% female) received IACS and were matched to a control. Although there was no difference in influenza odds by IACS status overall (odds ratio, 1.13; 95% confidence interval, 0.97-1.32), patients receiving IACS during influenza season had higher odds of influenza than matched controls (odds ratio, 1.34; 95% confidence interval, 1.03-1.74). Furthermore, unvaccinated patients who received IACS during influenza season had higher influenza odds compared with matched controls (odds ratio, 1.41; 95% confidence interval, 1.04-1.91]), whereas there was no difference among vaccinated patients.
Patients receiving IACS injections during influenza season had higher odds of influenza. However, vaccination seemed to mitigate this risk. Patients receiving IACS injections should be counseled on infection risk and importance of vaccinations. Further research is needed to examine IACS effects on other viral illnesses.
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Upon completion of this article, the reader should be able to: (1) Identify potential adverse effects of intra-articular corticosteroids; (2) Recognize risk factors for influenza diagnosis; and (3) Describe importance of influenza vaccination.
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The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.
尽管关节内皮质类固醇（IACS）是局部注射的，但仍会发生一些全身吸收，这可能导致接受者的免疫抑制。本研究检查了接受 IACS 治疗的患者与匹配对照者相比患流感的几率。
作者所在医疗系统中 2012 年 5 月至 2018 年 4 月期间接受 IACS 治疗的成年人与未接受 IACS 治疗的成年人进行 1:1 匹配。主要结局是总体流感发病几率。次要分析检查了 IACS 时机、关节大小和疫苗接种状态对流感发病几率的影响。
共有 23368 名成年人（平均年龄 63.5 岁，62.5%为女性）接受了 IACS 治疗，并与对照组进行了匹配。尽管总体上 IACS 状态对流感发病几率没有差异（比值比，1.13；95%置信区间，0.97-1.32），但在流感季节接受 IACS 治疗的患者比匹配的对照组患者患流感的几率更高（比值比，1.34；95%置信区间，1.03-1.74）。此外，在流感季节接受 IACS 治疗且未接种疫苗的患者患流感的几率高于匹配对照组（比值比，1.41；95%置信区间，1.04-1.91]），而接种疫苗的患者之间没有差异。
在流感季节接受 IACS 注射的患者患流感的几率更高。然而，疫苗接种似乎减轻了这种风险。接受 IACS 注射的患者应接受有关感染风险和疫苗接种重要性的咨询。需要进一步研究来检查 IACS 对其他病毒性疾病的影响。
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CME 目标：完成本文后，读者应能够：（1）识别关节内皮质类固醇的潜在不良反应；（2）认识流感诊断的危险因素；（3）描述流感疫苗接种的重要性。
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学术物理治疗医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理治疗医师协会将此基于期刊的 CME 活动指定为最多 1.0 项 AMA PRA 类别 1 学分 ™ . 医生只能声称与其参与活动程度相符的学分。
