Keywords
sacroiliac joint
bone marrow edema
ultrasound
How to Cite
Abstract
Background: The value of steroid and lidocaine injection of the sacroiliac joint in axial spondyloarthritis patients on magnetic resonance imaging scores and clinical disease outcome measures is not yet well assessed.
Patient and methods: Participants were randomly assigned into two groups; Group I received unilateral ultrasound-guided sacroiliac joint injection with .5% lidocaine hydrochloride mixed with triamcinolone. At the same time, group II received subcutaneous saline injection. All participants fulfilled the ASAS criteria for axial SpA and all had bone marrow edema of at least one sacroiliac joint at baseline. Outcomes measures were: Visual Analogue Scale (VAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), and Spondyloarthritis Research Consortium of Canada (SPARCC) scores. Participants were assessed at baseline (before and after sacroiliac joint injection) and after three months. This clinical trial was registered on clinicaltrials.gov under the number NCT04895228.
Results: In this study, a total of 61 participants were registered. There was a significant difference between both groups regarding pain, spine mobility, SPARCC, and ASDAS scores in favor of group I. Spine mobility showed the earliest improvement, followed by pain whilst SPARCC, and ASDAS scores showed improvement after three months. Higher disease activity, younger age, and shorter disease duration were all associated with better outcomes. Bilateral hip involvement was a predictor of poor response.
Conclusion: Sacroiliac joint injection of lidocaine and triamcinolone in axial SpA patients is a cost-effective and practical technique for controlling pain, improving function, disease activity scores, and bone marrow edema with acceptable complications and relatively sustained effect.
References
Ward, M.M., et al., 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol, 2019. 71(10): p. 1599-1613.
Shahinyan, A., L. Margaryan, and S. Samuel, Ankylosing Spondylitis, in Pain: A Review Guide, A. Abd-Elsayed, Editor. 2019, Springer International Publishing: Cham. p. 1239-1241.
Antoni, C. and J. Braun, Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol, 2002. 20(6 Suppl 28): p. S152-7.
Soliman, E., et al., Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity. Mod Rheumatol, 2015. 25(3): p. 421-6.
Dawson, P., N. Dewar, and D. Tulloch-Reid, Fluoroscopy-guided intra-articular sacroiliac joint steroid injection for sacroiliitis in ankylosing spondylitis: a Case Report. The West Indian Medical Journal, 2014. 63(1): p. 109.
Hartung, W., et al., Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology, 2010. 49(8): p. 1479-1482.
Lee, S., et al., AB0755 An intraarticular sacroiliac corticosteroid injections in ankylosing spondylitis. 2015, BMJ Publishing Group Ltd.
Kokar, S., et al., The role of sacroiliac joint steroid injections in the treatment of axial spondyloarthritis. Archives of Rheumatology, 2021. 36(1): p. 80.
Machado, P.M., et al., Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis, 2018. 77(10): p. 1539-1540.
Assassi, S., et al., New Population‐Based Reference Values for Spinal Mobility Measures Based on the 2009–2010 National Health and Nutrition Examination Survey. Arthritis & Rheumatology, 2014. 66(9): p. 2628-2637.
Haywood, K., et al., Spinal mobility in ankylosing spondylitis: reliability, validity and responsiveness. Rheumatology, 2004. 43(6): p. 750-757.
Migliore, A., et al., A new technical contribution for ultrasound-guided injections of sacro-iliac joints. European review for medical and pharmacological sciences, 2010. 14: p. 465-9.
Singla, V., et al., Steroid vs. platelet‐rich plasma in ultrasound‐guided sacroiliac joint injection for chronic low back pain. Pain Practice, 2017. 17(6): p. 782-791.
Elsaman, A.M., et al., Low-dose spironolactone: treatment for osteoarthritis-related knee effusion. A prospective clinical and sonographic-based study. The Journal of rheumatology, 2016. 43(6): p. 1114-1120.
Carlsson, A.M., Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 1983. 16(1): p. 87-101.
Crichton, N., Visual analogue scale (VAS). J Clin Nurs, 2001. 10(5): p. 706-6.
Machado, P.M., R. Landewé, and D. van der Heijde, Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Annals of the rheumatic diseases, 2018. 77(10): p. 1539-1540.
Madsen, O.R., Stability of fatigue, pain, patient global assessment and the Bath Ankylosing Spondylitis Functional Index (BASFI) in spondyloarthropathy patients with stable disease according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Rheumatology International, 2018. 38(3): p. 425-432.
LandewÉ, R.B., et al., Scoring sacroiliac joints by magnetic resonance imaging. A multiple-reader reliability experiment. The Journal of Rheumatology, 2005. 32(10): p. 2050-2055.
Maksymowych, W.P., et al., Modification of structural lesions on MRI of the sacroiliac joints by etanercept in the EMBARK trial: a 12-week randomised placebo-controlled trial in patients with non-radiographic axial spondyloarthritis. Annals of the rheumatic diseases, 2018. 77(1): p. 78-84.
Elsaman, A., A. Hamed, and A. Radwan, Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. The Korean journal of pain, 2021. 34(1): p. 114.
Soliman, E., et al., Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity. Modern rheumatology, 2015. 25(3): p. 421-426.
Hanly, J., et al., Efficacy of sacroiliac corticosteroid injections in patients with inflammatory spondyloarthropathy: Results of a 6 month controlled study. The Journal of rheumatology, 2000. 27: p. 719-22.
Maugars, Y., et al., Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol, 1996. 35(8): p. 767-70.
Cui, Y., et al., Evaluation of treatments for sacroiliitis in spondyloarthropathy using the Spondyloarthritis Research Consortium Canada scoring system. Arthritis research & therapy, 2016. 18(1): p. 1-7.
Pekkafali, M.Z., et al., Sacroiliac Joint Injections Performed With Sonographic Guidance. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2003. 22: p. 553-9.
Fouad, A.Z., et al., The Success Rate of Ultrasound‐Guided Sacroiliac Joint Steroid Injections in Sacroiliitis: Are We Getting Better? Pain Practice, 2021. 21(4): p. 404-410.
Jee, H., et al., Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: a prospective, randomized, single-blinded study. Archives of physical medicine and rehabilitation, 2014. 95(2): p. 330-337.
Chang, W.-H., H.L. Lew, and C.P. Chen, Ultrasound-guided sacroiliac joint injection technique. American journal of physical medicine & rehabilitation, 2013. 92(3): p. 278-279.
Schneider, B., J. Patel, and C. Smith, Ultrasound guidance for intra-articular Sacroiliac joint injections. Pain Medicine, 2020.
This work is licensed under a Creative Commons Attribution 4.0 International License.