AB0756 First Spanish study on the effectiveness of ultrasound-guided injection of corticosteroids into the sacroiliac joint of patients with spondyloarthritis.

Abstract

BackgroundSacroiliitis may be the main manifestation or a complication of any of the variants of spondyloarthritis. The few studies performed in patients with spondyloarthritis mainly evaluate the improvement in pain using a visual analog scale (VAS) and are limited by the need for an operating room and guidance based on fluoroscopy, tomography, or magnetic resonance. The advent of new ultrasound devices has meant that during the last decade, alternative approaches have been proposed for ultrasound-guided injection of the sacroiliac joint.ObjectivesTo determine clinical improvement (Bath Ankylosing Spondylitis Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS], acute-phase reactants, and the VAS score) after ultrasound-guided injection of corticosteroids into the sacroiliac joint of patients with spondyloarthritis.MethodsWe performed an observational, descriptive, and retrospective study at Ciudad Real General University Hospital (HGUCR), Ciudad Real, Spain. We reviewed the register of procedures carried out between June 1, 2020 and May 31, 2021 and included all patients with spondyloarthritis and inflammatory low back pain despite treatment with nonsteroidal anti-inflammatory drugs, biologics, or both. All patients underwent ultrasound-guided injection of the sacroiliac joint with corticosteroids (betamethasone chronodose 6/6 mg in each joint). We excluded patients whose clinical history did not contain the study variables and in whom modifications to pharmacologic treatment could have reduced the effectiveness of the injection.The outcome measures were presence of adverse effects/complications, reduction in the VAS score for inflammatory pain (>0=3 points), reduction of ≥1.1 points in the ASDAS score, reduction of ≥2 points in the BASDAI score, and reduced CRP and ESR values. These data were analyzed by comparing means (t test) for the variables VAS, BASDAI, ASDAS, CRP, and ESR. The potential association between the variables and a favorable clinical response was evaluated by calculating the odds ratio.The protocol was approved by the Research and Ethics Committee of Integrated Care Management, Ciudad Real, Spain.ResultsWe analyzed 32 patients with spondyloarthritis (age 42.69±8.19 years; female sex, 56.25%) with a VAS score of 7.88±0.79, BASDAI of 5.43±1.48, and ASDAS of 3.27±0.86 before the procedure. At 2-3 months, 75% of patients had improved: VAS 3.81±2.33 (–4.07, p<0.0001) and BASDAI 3.24 ± 1.6 (–2.19, p<0.0001). At 5-6 months, 59.37% had improved: VAS 4.63±2.31 (–3.25, p<0.0001), BASDAI 3.57±1.67 (–1.86, p<0.0001), and ASDAS 2.27±0.71 (–1.0, p<0.0001). Bone marrow edema resolved in 87.5% of cases compared with the previous magnetic resonance scan.Analysis of factors potentially associated with improved clinical response as measured using the VAS, BASDAI, and ASDAS did not reveal a significant association with the variables analyzed (age, time since diagnosis, grade of sacroiliitis by radiography, presence of HLA B27 (+), peripheral and extra-articular manifestations, type of treatment). However, all the patients whose symptoms improved (EVA, BASDAI, and ASDAS) had had bone marrow edema on their magnetic resonance scan <1 year before the treatment.Only 5 patients experienced injection site pain, which lasted 1-2 days. No other adverse effects were reported.ConclusionUltrasound-guided injection of corticosteroids into the sacroiliac joint of patients with spondyloarthritis and active sacroiliitis leads to an improvement in symptoms that is maintained at 5-6 months. The procedure is effective, safe, inexpensive, and easy to apply.References[1]Wendling D. Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence? Joint Bone Spine. 2020; 87 (3):209–213.[2]Kokar S, Kayhan O, Secan S, Gunduz OH. The role of sacroiliac joint steroid injections in the treatment of axial spondyloarthritis. Arch Rheumatol 2021;36 (1):80-88.AcknowledgementsWe acknowledgement the work and dedication of the rheumatology deparment, interventional rheumatology and pain medicine department teams.Disclosure of InterestsNone declared