Management of patients with musculoskeletal and rheumatic conditions who: are on corticosteroids; require initiation of oral/IV corticosteroids; require a corticosteroid injection.

This supersedes the specialist guidance “Management of Patients with Musculoskeletal and Rheumatic Conditions on Corticosteroids” published as part of the NHS England and Improvement phase 1 response to the coronavirus pandemic.

It relates to musculoskeletal (MSK) service provision across primary, community and secondary care and is applicable to adults and children. The use of steroid medication is one of the management options for a range of musculoskeletal conditions and in particular rheumatic conditions, and this guidance aims to assist decisions on the use of such medication during the pandemic. 

It is supported by the British Society for Rheumatology, British Association of Orthopaedics, British Association of Spinal Surgeons, Royal College of General Practitioners, British Society of Interventional Radiology, Faculty of Pain  Medicine, British Pain Society and Chartered Society of Physiotherapy

Steroids – oral and injected – can be an important and effective treatment for some MSK conditions, particularly rheumatic conditions, some types of arthritis and joint pain. Sometimes these can be lifesaving. Stopping steroids suddenly can be dangerous, and patients should only do so under clinical supervision.

There is concern that steroids can increase the risk from the novel coronavirus (COVID-19). Therefore, healthcare professionals should always consider alternatives to steroids where possible. If steroids are needed, the lowest possible dose should be used for the shortest possible time. If people are already taking steroids, consideration should be given on whether the dose can be safely reduced. Only give steroid injections for severe symptoms, and where there are no other options. Corticosteroids (either oral or parenteral) should only be initiated following careful counselling of patients and shared decision making.