We are emerging from not only the grey and cold of winter but a year of cocooning on account of the COVID-19 pandemic. Sunshine and vaccines are here, welcoming in more opportunities for activity. When painful joints limit your ability to fully enjoy these days, your doctor may recommend a cortisone (steroid) injection or spine facet ablation to help you stay active. The team of orthopedic interventionalists at ARA Health Specialists perform these procedures daily and are plugged in to work with your doctor! While locally injected steroids can provide relief from painful joint and back pain, only a vaccine can help your body fight off the virus we’ve all been avoiding for over a year. The impact of corticosteroids on vaccine efficacy, especially injected around the spine or into joints, is not well studied, leading to a few good questions.
WHY MIGHT AN INJECTION IMPACT THE EFFICACY OF MY COVID –19 VACCINE?
Vaccines work by first causing an activation of your immune system (immune response) against the target virus and then a subsequent immune memory to prevent future infections. Corticosteroids are known to negatively impact the ability of your body to activate cells involved in the immune response and may affect memory immune cells. A 2018 observational study reported increased incidence of flu infection in vaccinated patients who received a single joint injection compared to a similar group who had not received an injection, suggesting that the steroid injection may have resulted in decreased vaccine efficacy .
WERE THE COVID VACCINES TESTED IN PATIENTS RECEIVING STEROID INJECTIONS?
Published vaccine trials allowed patients with limited steroid exposure to participate but no analysis was provided to inform whether those who were exposed to corticosteroid before or after vaccination had reduced efficacy compared to those who were not exposed to corticosteroid. Neither study reported if participants who contracted COVID-19 had received a joint/spine injection. We have good data that shows that vaccines are effective in patients on long term oral steroids.
HOW DO I PLAN MY INJECTION AROUND MY VACCINE?
There is currently NO EVIDENCE that your pain procedure will negatively impact the efficacy of your vaccine. However, based on general knowledge of the duration of time steroids impact immune cells and limited data related to the impact of an injection on flu vaccine efficacy, your doctors at ARAHS are recommending that patients schedule their elective pain procedure at least 2 weeks before or one week after shots one or two of an mRNA COVID-19 vaccine (Moderna, Pfizer/BioNTech) and either 2 weeks before or 2 weeks after an adenovirus vector based vaccine (Johnson & Johnson, AstraZeneca), whenever possible. This is in line with Spine Intervention Society guidelines, an advocacy, research, and education-centered organization with an established reputation for development and promotion of the highest practice standards for interventional pain procedures.
When the opportunity to get a COVID vaccine comes your way, take it! We are all looking forward to enjoying more activities together as nature renews itself this Spring. If you have an elective procedure involving corticosteroids planned, ARA Health Specialists can work with you to make sure both are scheduled appropriately.
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