November 2023 CME Activity: Odds of Influenza in Patients Receiving Intra-articular Corticosteroid Injections A Cohort Study-Odds of Influenza in Patients Receiving Intra-articular Corticosteroid Injections A Cohort Study

Odds of Influenza in Patients Receiving Intra-articular Corticosteroid Injections A Cohort Study

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This cohort study investigates the relationship between intra-articular corticosteroid (IACS) injections and the likelihood of influenza in patients within the Mayo Clinic health system from May 2012 to April 2018. The research primarily aimed to determine if patients receiving IACS had higher odds of contracting influenza compared to a control group of matched adults.<br /><br />A total of 23,368 adults who received IACS were matched 1:1 with controls based on age, sex, and influenza vaccination status. The study found no significant overall difference in influenza odds between the IACS and control groups (odds ratio, 1.13; 95% confidence interval, 0.97–1.32). However, patients who received IACS during the influenza season exhibited higher odds of contracting influenza (odds ratio, 1.34; 95% confidence interval, 1.03–1.74). This increased risk was notably higher in unvaccinated patients who received IACS during the influenza season compared to their matched controls (odds ratio, 1.41; 95% confidence interval, 1.04–1.91). Conversely, no significant difference was observed among vaccinated patients.<br /><br />The study concluded that receiving IACS injections during influenza season is associated with a heightened risk of contracting influenza, particularly among unvaccinated individuals. This highlights the protective effect of influenza vaccination, which appeared to mitigate the increased risk posed by IACS. Therefore, it is essential to counsel patients on the importance of influenza vaccination prior to IACS administration.<br /><br />Key methodological elements included the use of electronic health records to identify cases and controls, rigorous matching criteria, and adjustments for comorbidities like chronic obstructive pulmonary disease, diabetes, and rheumatoid arthritis. Results suggest potential systemic immunosuppression due to IACS, with a dose-related response indicated by higher risks in patients receiving large joint injections.<br /><br />The findings underscore the importance of vaccination and may inform clinical practices regarding patient counseling and pre-procedural care for those considering or receiving IACS injections. Further research is needed to explore the effects of IACS on other viral infections and to delineate the optimal timing for vaccinations relative to IACS administration.

Keywords

intra-articular corticosteroid

IACS

influenza

Mayo Clinic

cohort study

vaccination

risk

electronic health records

immunosuppression

patient counseling