Local Steroid Injections as a New Treatment Option for Sacroiliitis

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 23 (V 93). 1998;

Abstract: Department of Rheumatology Nantes Spondylarthropathies are usually well controlled with intermittent NSAID treatment. Nevertheless it is not infrequent that axial involvement remains substantially painful despite NSAID or disappointing DMARD's. So local corticosteroid injection could be an interesting option but sacroiliac joints were considered inaccessible: colon nerve roots and ureter in an anterior approach posterosuperior iliac spine in a posterior approach. But down this tuberosity there is an easy access to the posterior and inferior synovial part of the sacroiliac joint. First we performed 42 sacroiliac injections in an open study with a long acting corticoid under fluoroscopic and arthrographic control. We obtained 81 % of good or very good results. NSAID were stopped in 44 % of patients and reduced by more than 50 % in 33 % of patients. Results were maintained in 74 % of patients with a mean follow up of 9.6 months. Second we performed a double blind study on 13 injections. Dolometer decreased markedly from 6.8 + 0.6 to 1.3 + 0.3 in comparison with a mild placebo effect in control group: 7.0 + 0.6 to 5.2 + 0.5 p = 0.005. Good results were maintained in 86 % of patients at 1 month 62 % at 3 months 58 % at 6 months. Despite more than 300 sacroiliac injections with a set-back of more than 7 years we did not have any notable complication. Further study with CT-Scan control of the injection confirmed these interesting results in painful sacroiliitis. X-ray-guided injections can permit an access in deep and usually unapproached sites as sacroiliac joints. ... le

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