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To Inject or Not to inject (the SI joint)?
June 15 2017 10:02 AM ET — via RheumReports
Sacroiliac pain can be treated with intra-articular corticosteroid injections in patients with SpA. While a few studies suggested that sacroiliac pain responds to intra-articular injections, the relation between response and the presence of inflammatory lesions on MRI is unknown.
The results of an observational study presented at the abstracts session (OP0029) at EULAR on June 14 suggest that intra-articular injections to the sacroiliac joints may be beneficial but there is poor association with inflammatory lesions on MRI.
This observational study enrolled patients with axial or peripheral SpA who had inflammatory unilateral or bilateral buttock pain. The patients underwent an MRI prior to the injection and the results were scored independently of the clinical data. Long-acting corticosteroids were injected to the symptomatic sacroiliac joint without knowing the MRI results.
The study included 31 patients who received a total of 34 injections. Overall, 13 patients achieved ≥50% improvement in the level of global pain (mean duration for achieving this outcome: 23 days), six patients achieved <50% improvement, and four patients did not achieve any improvement. There was also a significant decrease in provoked and unprovoked sacroiliac pain. No significant change was noted in BASDAI, BASFI, ASDAS scores or inflammatory markers.
Additionally, no association was noted between baseline global sacroiliac MRI score or the presence of inflammatory sacroiliac lesions on MRI and the chances of achieving clinical response.
The take-away is that corticosteroid injection to the sacroiliac joint could be beneficial in patients with SpA who experience localized sacroiliac pain, but MRI may not be helpful in predicting response. However, the results of this study should be interpreted with caution since this is an observational study that did not include a placebo arm.
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About the Author
Dr. Lihi Eder
Dr. Lihi Eder is an Assistant Professor of Medicine at the University of Toronto and Staff Rheumatologist and Director of the Psoriatic Arthritis Research Program at Women’s College Hospital. Dr. Eder is a Scientist at Women’s College Research Institute and associate member of the graduate faculty at the Institute of Medical Science.
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