Skip to main content

Advertisement

SpringerLink
Log in

CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Steroid injection of the sacroiliac joints is widely used for the management of active sacroiliitis in patients with spondyloarthritis (SpA). The aims of this study were to prospectively investigate the effectiveness of corticosteroid injection of the sacroiliac joints and to identify factors determining positive and negative outcome. Twenty-nine patients (18 female, 11 male) suffering from sacroiliitis were treated by computed tomography (CT)-guided administration of 40 or 60 mg triamcinolone acetonide per joint. Clinical outcome of the intervention was determined using a visual analog scale from days 1 to 7 as well as after 1, 3, and 6 months. Patients were grouped according to intra-articular (n = 22) and peri-articular positions (n = 7) of the tip of the puncture needle. In patients with intra-articular needle position (76 %), the mean pain score decreased significantly from 7.3 (±1.9) to 3.9 (±3.4) at day 7 and to 3.9 (±3.4) after 1 month, 4.2 (±3.3) after 3 months, and 5.2 (±2.9) after 6 months. The group with peri-articular needle position (24 %) did not show a statistically significant pain reduction throughout the entire 6-month follow-up period. A substantial reduction of inflammatory back pain (reduction of at least 4 visual analog scale (VAS) points) was reported by 55 % of patients after 3 months and 45 % of patients after 6 months. Our results demonstrate that intra-articular CT-guided steroid instillation can achieve sufficient pain and symptom control for 6 months in patients suffering from active sacroiliitis. It is therefore recommended to perform this intervention under appropriate image guidance to ensure proper positioning of the needle tip.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369(9570):1379–90

    Article  PubMed  Google Scholar 

  2. Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X et al (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68(10):1520–7

    Article  CAS  PubMed  Google Scholar 

  3. Baraliakos X, Listing J, Rudwaleit M, Haibel H, Brandt J, Sieper J et al (2007) Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis 66(7):910–5

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. van der Linden S, van der Heijde D (1998) Ankylosing spondylitis. Clinical features. Rheum Dis Clin North Am 24(4):663–76, 4

    Article  PubMed  Google Scholar 

  5. Hermann KG, Braun J, Fischer T, Reisshauer H, Bollow M (2004) Magnetic resonance tomography of sacroiliitis: anatomy, histological pathology, MR-morphology, and grading. Radiologe 44(3):217–228

    Article  CAS  PubMed  Google Scholar 

  6. Hermann KG, Bollow M (2014) Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis: correlation with anatomy and histology. Rofo 186(3):230–7

    PubMed  Google Scholar 

  7. Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B et al (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65(4):442–52

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A (1996) Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol 35(8):767–70

    Article  CAS  PubMed  Google Scholar 

  9. Gunaydin I, Pereira PL, Daikeler T, Mohren M, Trubenbach J, Schick F et al (2000) Magnetic resonance imaging guided corticosteroid injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study. J Rheumatol 27(2):424–8

    CAS  PubMed  Google Scholar 

  10. Fritz J, Konig CW, Gunaydin I, Clasen S, Kastler B, Kotter I et al (2005) Magnetic resonance imaging-guided corticosteroid-infiltration of the sacroiliac joints: pain therapy of sacroiliitis in patients with ankylosing spondylitis. Rofo 177(4):555–63

    Article  CAS  PubMed  Google Scholar 

  11. Fischer T, Biedermann T, Hermann KG, Diekmann F, Braun J, Hamm B et al (2003) Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-guided intra-articular corticosteroid injection. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 175(6):814–21

    Article  CAS  PubMed  Google Scholar 

  12. Braun J, Bollow M, Seyrekbasan F, Haberle HJ, Eggens U, Mertz A et al (1996) Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 23(4):659–64

    CAS  PubMed  Google Scholar 

  13. Althoff CE, Feist E, Burova E, Eshed I, Bollow M, Hamm B et al (2009) Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Radiol 71(2):232–6

    Article  PubMed  Google Scholar 

  14. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol JVIR 14(9 Pt 2):S199–202

    Article  Google Scholar 

  15. Underwood MR, Dawes P (1995) Inflammatory back pain in primary care. Br J Rheumatol 34(11):1074–7

    Article  CAS  PubMed  Google Scholar 

  16. Singh G, Ramey DR, Morfeld D, Shi H, Hatoum HT, Fries JF (1996) Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med 156(14):1530–6

    Article  CAS  PubMed  Google Scholar 

  17. Rosenberg JM, Quint TJ, de Rosayro AM (2000) Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain 16(1):18–21

    Article  CAS  PubMed  Google Scholar 

  18. Hansen HC (2003) Is fluoroscopy necessary for sacroiliac joint injections? Pain Physician 6(2):155–8

    PubMed  Google Scholar 

  19. D'Orazio F, Gregori LM, Gallucci M (2015) Spine epidural and sacroiliac joints injections—when and how to perform. Eur J Radiol 84(5):777–82

  20. Cui Y, Xiao Z, Shuxia W, Zhenjun Z, Hengguo Z, Liangyi F et al (2010) Computed tomography guided intra-articular injection of etanercept in the sacroiliac joint is an effective mode of treatment of ankylosing spondylitis. Scand J Rheumatol 39(3):229–32

    Article  CAS  PubMed  Google Scholar 

  21. Stoeckelhuber BM, Leibecke T, Schulz E, Melchert UH, Bergmann-Koester CU, Helmberger T et al (2005) Radiation dose to the radiologist’s hand during continuous CT fluoroscopy-guided interventions. Cardiovasc Intervent Radiol 28(5):589–94

    Article  PubMed  Google Scholar 

  22. Karpitschka M, Augart D, Becker HC, Reiser M, Graser A (2013) Dose reduction in oncological staging multidetector CT: effect of iterative reconstruction. Br J Radiol 86(1021):20120224

    Article  CAS  PubMed  Google Scholar 

  23. Kloeckner R, dos Santos DP, Schneider J, Kara L, Dueber C, Pitton MB (2013) Radiation exposure in CT-guided interventions. Eur J Radiol 82(12):2253–7

    Article  PubMed  Google Scholar 

  24. Artner J, Cakir B, Reichel H, Lattig F (2012) Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations. Journal of pain research 5:265–9

    Article  PubMed Central  PubMed  Google Scholar 

  25. Report of the German Federal Office for Radiation Protection. (2002). http://www.bfs.de/en/ion/beruf_schutz/strahlenschutzregister.html

  26. Maurer MH, Schreiter N, de Bucourt M, Grieser C, Renz DM, Hartwig T et al (2013) Cost comparison of nerve root infiltration of the lumbar spine under MRI and CT guidance. Eur Radiol 23(6):1487–94

    Article  CAS  PubMed  Google Scholar 

  27. Fischbach F, Eggemann H, Bunke J, Wonneberger U, Ricke J, Strach K (2012) MR-guided freehand biopsy of breast lesions in a 1.0-T open MR imager with a near-real-time interactive platform: preliminary experience. Radiology 265(2):359–70

    Article  PubMed  Google Scholar 

  28. Pekkafahli MZ, Kiralp MZ, Basekim CC, Silit E, Mutlu H, Ozturk E et al (2003) Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med Off J Am Inst Ultrasound Med 22(6):553–9

    Google Scholar 

  29. Klauser A, De Zordo T, Feuchtner G, Sogner P, Schirmer M, Gruber J et al (2008) Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 59(11):1618–24

    Article  PubMed  Google Scholar 

  30. Klauser AS, De Zordo T, Feuchtner GM, Djedovic G, Weiler RB, Faschingbauer R et al (2010) Fusion of real-time US with CT images to guide sacroiliac joint injection in vitro and in vivo. Radiology 256(2):547–53

    Article  PubMed  Google Scholar 

  31. Zacchino M, Almolla J, Canepari E, Merico V, Calliada F (2013) Use of ultrasound-magnetic resonance image fusion to guide sacroiliac joint injections: a preliminary assessment. J Ultrasound 16(3):111–8

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Hartung W, Ross CJ, Straub R, Feuerbach S, Scholmerich J, Fleck M et al (2010) Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology (Oxford) 49(8):1479–82

    Article  Google Scholar 

  33. Sakamoto N, Yamashita T, Takebayashi T, Sekine M, Ishii S (2001) An electrophysiologic study of mechanoreceptors in the sacroiliac joint and adjacent tissues. Spine (Phila Pa 1976) 26(20):E468–71

    Article  CAS  Google Scholar 

  34. Althoff CE, Sieper J, Song IH, Haibel H, Weiss A, Diekhoff T et al (2013) Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis 72(6):967–73

    Article  PubMed  Google Scholar 

  35. Gunaydin I, Pereira PL, Fritz J, Konig C, Kotter I (2006) Magnetic resonance imaging guided corticosteroid injection of sacroiliac joints in patients with spondylarthropathy. Are multiple injections more beneficial? Rheumatol Int 26(5):396–400

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Charité Medical University, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Christian E. Althoff, Stephan R. Marticorena-Garcia, Torsten Diekhoff, Bernd Hamm & Kay Geert A. Hermann

  2. Department of Radiology, Augusta Kranken Anstalt, Bochum, Germany

    Matthias Bollow

  3. Medical Department of Clinical Immunology and Rheumatology, Charité Medical University, Campus Mitte, Berlin, Germany

    Eugen Feist

  4. Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel

    Iris Eshed

Authors
  1. Christian E. Althoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Bollow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugen Feist
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephan R. Marticorena-Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iris Eshed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Torsten Diekhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bernd Hamm
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kay Geert A. Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kay Geert A. Hermann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Althoff, C.E., Bollow, M., Feist, E. et al. CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months. Clin Rheumatol 34, 1079–1084 (2015). https://doi.org/10.1007/s10067-015-2937-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-015-2937-7

Keywords

Search

Navigation