Kreulen R Timothy, Margalit Adam, Miller Andrew S, Srikumaran Uma, Wilckens John H, Laporte Dawn
Arch Bone Jt Surg. 2023;11(5):306-312. doi: 10.22038/ABJS.2023.68418.3263.
Orthopedic surgeons commonly perform corticosteroid injections. These injections have systemic side effects, including suppression of the hypothalamic-pituitary adrenal axis. Due to this suppression, there is a theoretical risk of corticosteroid injections affecting the efficacy of the novel COVID-19 vaccines. This potential interaction led the American Academy of Orthopedic Surgeons to recommend, "avoiding musculoskeletal corticosteroid injections for two weeks before and one week after COVID vaccine administration." This review examines the literature underlying this recommendation. An extensive literature review was performed through PubMed, MEDLINE, and Google Scholar from database inception to May 2022. Keywords searched were COVID, coronavirus, vaccine, vaccination, steroids, and corticosteroids. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. There is no definitive evidence that corticosteroid injections affect COVID-19 vaccine efficacy or increase the risk of contracting COVID. The authors recommend orthopedic surgeons follow the AAOS guidelines, which recommend avoiding injections two weeks before and one week following COVID vaccine administration. Additional research is needed to better define this theoretical risk, especially since there is good evidence that injections suppress the hypothalamic-pituitary-adrenal-axis.
骨科医生经常进行皮质类固醇注射。这些注射会产生全身性副作用,包括抑制下丘脑-垂体-肾上腺轴。由于这种抑制作用,理论上存在皮质类固醇注射影响新型冠状病毒肺炎(COVID-19)疫苗效力的风险。这种潜在的相互作用促使美国骨科医师学会建议,“在接种COVID疫苗前两周和接种后一周避免进行肌肉骨骼皮质类固醇注射”。本综述探讨了这一建议背后的文献依据。通过PubMed、MEDLINE和谷歌学术进行了广泛的文献综述,检索时间从数据库建立至2022年5月。检索关键词为COVID、冠状病毒、疫苗、接种、类固醇和皮质类固醇。搜索结果包括用英文撰写的文章,涵盖综述、病例系列、实证研究和基础科学文章。没有确凿证据表明皮质类固醇注射会影响COVID-19疫苗效力或增加感染COVID的风险。作者建议骨科医生遵循美国骨科医师学会(AAOS)的指南,该指南建议在接种COVID疫苗前两周和接种后一周避免注射。需要进行更多研究以更好地界定这种理论风险,特别是因为有充分证据表明注射会抑制下丘脑-垂体-肾上腺轴。
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