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Ultrasound guided corticosteroids sacroiliac joint injections (SIJIs) in the management of active sacroiliitis: a real-life prospective experience

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Abstract

Introduction

Active sacroiliitis represents the hallmark of axial spondyloarthritis (axSpA) and manifests as inflammatory low back pain associated with morning stiffness (MS). Sometimes, the combination of non-steroidal anti-inflammatory drugs (NSAIDs) and biological disease modifying drugs (bDMARDs) proves unsatisfactory in achieving a remission.

Materials and methods

We enrolled patients affected with active sacroiliitis confirmed via magnetic resonance imaging (MRI) and treated with a corticosteroid sacroiliac joint injection (SIJI) via ultrasound guidance.

After SIJI, we evaluated visual–analogue scale (VAS) and MS pain changes. As controls, we selected axSpA patients starting bDMARDs.

Results

We enrolled 26 patients (mean age 55 ± 14 years; 25 females and 1 male; > 95% treated with NSAIDs; 46% on bDMARDs; 75.82 ± 123 months) and examined a total of 47 treated joints. We detected a 48% reduction in VAS pain after 24 h. Moreover, we observed a significant reduction (p < 0.0001) of VAS pain between the baseline and every subsequent follow-up visit. Further, a significant difference in VAS pain compared to the baseline in the controls was observed starting from week 12. There was a significant reduction in MS after 1 week due to SIJIs, while in the controls the first significant change from the baseline in MS was detected after 12 weeks. The efficacy of infiltrative therapy lasted up to 6 months: persistent VAS as well as MS pain reduction was observed.

Conclusions

US-guided SIJI represents an effective and safe technique for patients who have active sacroiliitis yet are ineligible for biologic treatment or who experience unsatisfactory disease control despite receiving therapy.

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Authors and Affiliations

  1. Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy

    Suhel G. Al Khayyat, Giuseppe Fogliame, Stefano Barbagli, Edoardo Conticini, Marta Fabbroni, Roberto D’Alessandro, Antonio Vitale, Stefano Gentileschi, Marco Bardelli, Caterina Baldi, Paolo Falsetti, Luca Cantarini & Bruno Frediani

  2. Advanced Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, SIUMB School of Pisa, Santa Chiara University Hospital, Pisa, Italy

    Salvatore Massimo Stella

  3. Advanced Musculoskeletal Ultrasound, SIUMB School of San Giovanni Rotondo, Foggia, Italy

    Annarita Saponara

  4. Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy

    Andrea Del Chiaro

  5. Orthopedic and Traumatology Operating Unit, San Luca Hospital, Lucca, Italy

    Andrea Del Chiaro

Authors
  1. Suhel G. Al Khayyat
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  2. Giuseppe Fogliame
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  9. Marco Bardelli
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  12. Annarita Saponara
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  13. Andrea Del Chiaro
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  14. Paolo Falsetti
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  15. Luca Cantarini
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  16. Bruno Frediani
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Corresponding author

Correspondence to Suhel G. Al Khayyat.

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The authors deny any conflict of interest.

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The authors deny any funding.

Ethical Statements

The present study was approved by a local ethical committee (protocol number 22271) and conducted in accordance with the Declaration of Helsinki and its late amendments.

Informed consent

The infiltrative technique was explained to the patient and a written informed consent was obtained.

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Each patient provided written informed consent to be enrolled.

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Al Khayyat, S.G., Fogliame, G., Barbagli, S. et al. Ultrasound guided corticosteroids sacroiliac joint injections (SIJIs) in the management of active sacroiliitis: a real-life prospective experience. J Ultrasound 26, 479–486 (2023). https://doi.org/10.1007/s40477-022-00736-6

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  • DOI: https://doi.org/10.1007/s40477-022-00736-6

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