Background Active sacroiliitis represent the radiological hallmark of Ankylosing Spondylitis (Ax-SPA) and manifest as low back pain accompanied by morning stiffness (MS). The pain at rest as well as MS represent the main symptoms that impair patients’ quality of life. The treatment of Ax-SPA rely on non steroidal anti-inflammatory drugs (NSAIDs), monoclonal antibodies as Anti-TNF-α, anti interluekine-17/23 and, recently, on Janus Kinase Inhibitors; such compounds modify the disease natural history and reduce inflammation, thus restoring patient’s well being and quality of life. However, despite a full treatment regimen, sometimes it is not possible to reach a low disease activity or remission.

Objectives In rheumatological practice, corticosteroids (GCs) injections are successfully exploited in the every-day scenario to treat oligo-articular inflammatory disorders. In this context, we decided to evaluate the long-term efficacy of ultrasound-guided sacroiliac joint injections (US-SIJIs) of GCs in the treatment of active sacroiliitis and to understand whether local therapy has a role in the management of active sacroiliitis.

Methods We enrolled patients affected by Ax-SPA with active sacroiliitis from our outpatient clinic. Some were treated with an US-SIJI when starting a biological disease modifying rheumatic drug (bDMARD) while others were treated with conventional therapy (bDMARD + NSAIDs) and used as controls. Variables such as age, gender, disease duration, type of bDmard, visuo-analogic pain scale (VAS) and MS were collected at baseline. VAS and MS were collected at each follow up visit that were scheduled at 24 and 48 hours, then after 7 days, 14 days, 1, 3, 6, 9 and 12 months. Each patient treated with SIJI received an explanation of the technique and informed written consent was obtained; subsequently, each patient was invited to lay pronated on a medical bed while a musculoskeletal sonographer individuated sacroiliac joints (SIJ) with a convex probe and demarcated the needle entry site with a dermographic pen. A sterile hood was put on the probe, the skin was accurately disinfected, then a 2,5 mL syringe was loaded with 40 mg of triamcinolone acetonide and a spinal needle of 22 gauge was used to reach SIJ. Each SIJI involved crossing the posterior sacroiliac ligament and each injection was carried out following real time the needle trajectory. All of the US-SIJI patients received a bilateral SIJI. The statistical analysis exploited descriptive statistics to define baseline anthropometric variables, ANOVA test and Test U of Mann were used to compare the means between groups. The p<0,05 was considered significant. The present study was conducted in accordance to the Declaration of Helsinki and was approved by the local ethical committee.

Results We enrolled 33 subjects: 12 received an US SIJI and 21 were treated with a standard therapy according the most up-to-date recommendations. Both groups were comparable for age and VAS pain at baseline. In US-SIJI group after 24 h was documented a significant reduction of VAS pain that lasted up to 1 year displaying always a persistent significant lower value compared to baseline; in SIJIs group the higher VAS pain reduction from baseline was documented after 7 days (- 71%); in the control group VAS pain reduction reached significance after 3 months from baseline and the higher VAS pain reduction was documented at end of study (-32 %). In the US-SIJI group MS dropped significantly after two weeks from SIJI while in the controls after 3 months from baseline. At the end of study the patients treated with US-SIJI displayed a higher VAS pain (-50 % in SIJIs vs. -32 %, p<0,05) as well as MS reduction compared to controls (- 71 % in SIJIs vs – 42%, p<0,05). Any serious adverse event was recorded.

Conclusion The US-SIJIs represent a safe and useful tool to control the symptoms of an active sacroiliitis and they should be performed concomitantly to the beginning of a bDMARD therapy to guarantee a rapid restoration of patients’ quality of life.

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Figure 1.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests None Declared.