Background/Purpose: Ankylosing spondylitis (AS) is a chronic inflammatory disease which involves axial skeleton. NSAIDs are drug of choice and biologic disease-modifying anti-rheumatic drugs (DMARDs) are strongly recommended in case of NSAIDs failure. But some AS patients have intermittent, migratoy pain and inflammatory pain could last several days or weeks. Intraarticular injections of sacroiliac joints are recommended in these cases.

The goal of this study was to analyze the effectiveness of a fluoroscopy-guided intraarticular corticosteroid injection for the treatment of sacroiliac joint pain in patients with AS.

Methods: Between March 2012 and February 2015, a total of 62 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were performed in 58 patients with AS (37 males, 21 females; mean age 29.1 years, range 12 to 66 years). All patients had been previously diagnosed with AS according to the modified New York criteria And there were findings of active inflammation in their sacroiliac joints confirmed by pelvic magnetic resonance imaging (MRI).

The mixture of triamcinolone acetonide 40 mg and normal saline 0.5 mL was injected under floroscopic guidance.

Results: The mean disease duration before injection was 26.7 months (range 0 to 151 months) and the mean follow-up after injection was 15.1 months (range 0 to 35 months). After injection, BASDAI score and levels of acute phase reactant were decreased. The mean BASDAI score before injection was 6.26 (range 2.3 to 10.0) and the mean BASDAI score after injection was 4.81 (range 1.0 to 9.2). BASDAI 50%/20mm response rate was 27.4% (17/62). In 24 out of 62 cases (39.0%), the BASDAI score were below 4 which means optimal control of disease. No initiation of biologic DMARDs and additional intervention was required in 39 out of 54 patients (72.2%).

But 4 out of 58 patients (6.9%) needed a second injection. 3 patients already was on biologic DMARDs before injection, 15 patients newly started biologic DMRADs after injection due to their high disease activity and lack of effectiveness of intraarticular injection. There were neither discontinuity nor change of biologic DMARDs. There was no bilateral injection at once and no complication associated with the procedure. There was no significant difference between dose of medications which is prescribed before and after injection.

Conclusion: Fluoroscopy-guided corticosteroid injection into sacroiliac joint could be considered as one of treatment options instead of starting biologic DMARDs or dose escalation of medications, when AS patients complain of abrupt and severe pain in their sacroiliac joints.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/intraarticular-sacroiliac-corticosteroid-injections-in-ankylosing-spondylitis/