Background Ankylosing spondylitis is chronic inflammatory disease which involves axial skeleton. NSAIDs are drug of choice and biologics are strongly recommended in case of NSAIDs failure. But some AS patients have intermittent, migratory pain and inflammatory pain could last several days or weeks. Intraarticular injections of sacroiliac joints are recommended in these cases.
Objectives 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 December 2014, a total of 57 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were performed in 53 patients with ankylosing spondylitis (38 males, 15 females; mean age 29.8 years, range 12 to 66 years). The mixture of triamcinolone acetonide 40mg and normal saline 0.5 mL was injected under fluoroscopic guidance.
Results The mean disease duration before injection was 27.4 months (range 0 to 151 months) and the mean follow-up after injection was 13.6 months (range 0 to 32 months). The mean BASDAI score before injection was 5.83 (range 2.3 to 8.5) and the mean BASDAI score after injection was 4.77 (range 1.0 to 9.2). In 20 out of 53 patients (37.8%), the BASDAI score were below 4 which means optimal control of disease. No initiation of biologic agents and additional intervention was required in 37 out of 53 patients (69.8%). 4 out of 53 patients (7.5%) needed a second injection. 2 patients already was on biologics before injection, 12 patients newly started biologics after injection due to their high disease activity and lack of effectiveness of injection. There were neither discontinuity nor change of biologics. 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.
Conclusions When AS patients complain of abrupt and severe pain in their sacroiliac joint, rheumatologists can consider fluoroscopy-guided intraarticular corticosteroid injection as one of treatment options instead of starting biologics or dose escalation of medications.
Disclosure of Interest None declared