Corticosteroid injections during the COVID-19 pandemic: experience from a UK centre.

AIMS: To describe the incidence of adverse clinical outcomes related to COVID-19 infection following corticosteroid injections (CSI) during the COVID-19 pandemic. To describe the incidence of positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) testing, positive SARS-COV2 IgG antibody testing or positive imaging findings following CSI at our institution during the COVID-19 pandemic. METHODS: A retrospective observational study was undertaken of consecutive patients who had CSI in our local hospitals between 1 February and 30June 2020. Electronic patient medical records (EPR) and radiology information system (RIS) database were reviewed. SARS-CoV-2 RT-PCR testing, SARS-COV2 IgG antibody testing, radiological investigations, patient management, and clinical outcomes were recorded. Lung findings were categorized according to the British Society of Thoracic Imaging (BSTI) guidelines. Reference was made to the incidence of lab-confirmed COVID-19 cases in our region. RESULTS: Overall, 1,656 lab-confirmed COVID-19 cases were identified in our upper tier local authority (UTLA), a rate of 306.6 per 100,000, as of 30June 2020. A total of 504 CSI injections were performed on 443 patients between 1 February and 30June 2020. A total of 11 RT-PCR tests were performed on nine patients (2% of those who had CSI), all of which were negative for SARS-CoV-2 RNA, and five patients (1.1%) received an SARS-CoV-2 IgG antibody test, of which 2 (0.5%) were positive consistent with prior COVID-19 infection, however both patients were asymptomatic. Seven patients (1.6%) had radiological investigations for respiratory symptoms. One patient with indeterminate ground glass change was identified. CONCLUSION: The incidence of positive COVID-19 infection following corticosteroid injections was very low in our cohort and no adverse clinical outcomes related to COVID-19 infection following CSI were identified. Our findings are consistent with CSI likely being low risk during the COVID-19 pandemic. The results of this small observational study are supportive of the current multi-society guidelines regarding the judicious use of CSI.Cite this article: Bone Joint Open 2020;1-9:605-611.

Menopausal arthralgia: Fact or fiction.

Arthralgia is experienced by more then half of the women around the time of menopause. The causes of joint pain in postmenopausal women can be difficult to determine as the period of menopause coincides with rising incidence of chronic rheumatic conditions such as osteoarthritis. Nevertheless, prevalence of arthralgia does appear to increase in women with menopausal transition and is thought to result from reduction in oestrogen levels. Similar syndrome occurs following sudden withdrawal of hormone replacement therapy or treatment with aromatase inhibitors. Various interactions between sex hormones and pain processing pathways, immune cells and chondrocytes have been demonstrated but undoubtedly require further research. Whilst, at present, no specific treatment exists for menopausal arthralgia, a number of conservative measures may be effective. Hormone replacement therapy (HRT) has been shown to have some benefit in alleviating arthralgia associated with menopausal transition, and can be considered in women who report distressing vasomotor symptoms. Simple analgesia, weight loss and physical exercise should be encouraged particularly in women with underlying osteoarthritis. Finally, other factors commonly associated with chronic pain and menopausal transition such as fatigue, poor sleep, sexual dysfunction and depression need to be addressed.

Obesity and arthritis.

Obesity affects over 20% of the UK's adult population and its prevalence is rising. Obesity can lead to a variety of musculoskeletal problems and is independently associated with locomotor disability and joint pain. Obesity increases the risk of radiographic knee osteoarthritis (OA), but has a lesser effect on disease progression. The association with hip and hand OA is weaker, but implies that excess adipose tissue produces humoral factors, altering articular cartilage metabolism. It has been postulated that the leptin system could be a link between metabolic abnormalities in obesity and increased risk of OA. Although obesity was initially thought to increase the risk of rheumatoid arthritis (RA), further studies showed, that heavier patients with RA have less radiological disease progression and possibly better survival. On the other hand, obesity is strongly associated with hypeuricaemia and gouty arthritis. High body weight correlates independently with metabolic syndrome and may contribute to increased cardiovascular morbidity in patients with gout. Weight reduction should be an important part of treatment for OA and gout. Because obesity at a young age correlates with the development of OA and gout in later life, preventive public health strategies aimed at lowering the incidence of obesity are of most importance.