Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
Advanced Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, SIUMB School of Pisa, Santa Chiara University Hospital, Pisa, Italy.
J Ultrasound. 2023 Jun;26(2):479-486. doi: 10.1007/s40477-022-00736-6. Epub 2022 Oct 13.
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.
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.
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.
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.
活跃的骶髂关节炎是轴性脊柱关节炎（axSpA）的标志，表现为与晨僵相关的炎症性下腰痛。有时，联合使用非甾体抗炎药（NSAIDs）和生物疾病修正药物（bDMARDs）也无法达到缓解。
我们招募了经磁共振成像（MRI）证实患有活跃骶髂关节炎并接受超声引导下皮质类固醇骶髂关节注射（SIJI）治疗的患者。在 SIJI 后，我们评估了视觉模拟量表（VAS）和晨僵疼痛的变化。作为对照，我们选择了开始使用 bDMARDs 的 axSpA 患者。
我们共招募了 26 名患者（平均年龄 55 ± 14 岁；25 名女性，1 名男性；> 95%的患者使用 NSAIDs；46%的患者使用 bDMARDs；75.82 ± 123 个月），共检查了 47 个治疗关节。我们发现 24 小时后 VAS 疼痛减轻了 48%。此外，我们观察到 VAS 疼痛在基线和每次后续随访时都有显著降低（p < 0.0001）。此外，与对照组相比，在第 12 周开始观察到 VAS 疼痛有显著差异。SIJIs 治疗后 1 周，晨僵显著改善，而对照组在基线时首次观察到晨僵有显著变化是在第 12 周。浸润性治疗的疗效可持续长达 6 个月：VAS 和晨僵疼痛持续减轻。
超声引导下的 SIJI 是一种有效且安全的技术，适用于因不适合接受生物治疗或尽管接受治疗但疾病控制仍不理想而患有活跃骶髂关节炎的患者。
