Arthritis patients denied steroid injections

sir – Annie Laws’s GP (Letters, July 23) says that injecting a joint with steroid to treat arthritis would increase the risk of catching Covid-19.

The evidence for this is weak and is based on an American study in which the doses used were nearly eight times as high as is usual for knee injections in Britain. Even so, there were only about 450 cases of flu in over 15,000 patients who had joint injections.

Even if the risk was slightly increased, it would only be so for a few days, and it could be mitigated by advising strict distancing and hygiene for a week after the injection.

In the case of Charlie Barrass (Letters, July 11) and his painful thumb, the dose would be about a fifth or less of that for a knee and the risk therefore negligible.

Dr Michael Blackmore

Midhurst, West Sussex

sir – Having recently suffered a dislocated shoulder, I have found out what pain really is. If a few more doctors had suffered something similar they might have compassion for their arthritic patients denied help.

Eryl Tucker

Bedford

sir – The advice to NHS doctors on giving steroid injections during the pandemic is based on the effects of systemic steroid administration. While local steroid injections cause some immune-system suppression, it is nothing like as great as that caused by systemic steroids.

The Chief Pharmaceutical Officer advises that decisions are best made on a case-by-case basis, in considering the risk if a patient catches Covid-19 after a steroid injection into a joint.

Any patient who has reached this point in their treatment is obviously in pain, with some limitations to everyday activity. So an injection to help resolve this would be the treatment of choice.

Sue Hardy

Hitchin, Hertfordshire