Cortisone benefits and adverse effects

There is a concern amongst doctors and patients as to the long-term use of corticosteroids in managing chronic back, neck, and joint pain. Cortisone injections can help many people, they can also provide potential harm to others. The debate over the detrimental effects of corticosteroids intensified during the COVID-19 surge as corticosteroids suppress immune response.

A September 2021 paper (1) found: “There are growing concerns with the widely used glucocorticoids during the Coronavirus disease-19 (COVID-19) pandemic due to the associated immunosuppressive effects, which may increase the risk of COVID-19 infection and worsen COVID-19 patient outcome. Heavily affecting orthopaedics, the pandemic led to delay and cancellation of almost all surgical cases, and procedures including perioperative intra-articular corticosteroid injections (ICIs) saw similar decreases. However, the benefits of intra-articular corticosteroid injections treatments during the pandemic may outweigh these potential risks, and their continued use may be warranted.”

A July 2022 study (2) found in critically ill COVID-19 patients, dexamethasone (anti-inflammatory) as standard of care was strongly and independently associated with superinfections. The study notes that 43% of patients monitored developed  superinfections, pneumonia dominated (78%). Invasive fungal infections were reported  in dexamethasone-treated patients.

1 Jou E, Zhou AK, Ho JS, Thahir A. Perioperative use of intra-articular steroids during the COVID-19 pandemic. European Journal of Orthopaedic Surgery & Traumatology. 2021 Sep 1:1-1.

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