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Cocconi F, Maffulli N, Bell A, Memminger MK, Simeone F, Migliorini F. Sacroiliac joint pain: what treatment and when. Expert Rev Neurother 2024:1-8. [PMID: 39262128 DOI: 10.1080/14737175.2024.2400682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Spinal and non-spinal pathologies can cause low back pain. Non-spinal sources of low back pain include the sacroiliac joint (SIJ) and the hip. SIJ pain can be treated either conservatively or surgically. Current strategies for managing sacroiliac joint pain are debated, and limited evidence exists. AREAS COVERED The present expert opinion updates current evidence on conservative and surgical modalities for SIJ pain. EXPERT OPINION Surgical management for SIJ pain is effective. However, it exposes patients to surgery and, therefore, related complications. Conservative management may be implemented in patients with moderate SIJ pain, with less than six months of symptoms, or not eligible for surgery. Several noninvasive modalities are available, mostly centered on intra-articular injections. Corticosteroids, platelet-rich plasma, and stem cells have only midterm lasting effects, at most for nine months. Radiofrequency ablation is another methodology for pain relief. Both continuous and pulsatile radiofrequency ablation are associated with good outcomes. SIJ fusion can be performed using different techniques; however, a clear recommendation on the most appropriate modality for the management of SIJ pain is still debated.
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Affiliation(s)
- Federico Cocconi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Medicine and Psychology, University La Sapienza, Roma, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, UK
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Michael Kurt Memminger
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy
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2
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Al Khayyat SG, Fogliame G, Barbagli S, Conticini E, Fabbroni M, D'Alessandro R, Vitale A, Gentileschi S, Bardelli M, Baldi C, Stella SM, Saponara A, Del Chiaro A, Falsetti P, Cantarini L, Frediani B. Ultrasound guided corticosteroids sacroiliac joint injections (SIJIs) in the management of active sacroiliitis: a real-life prospective experience. J Ultrasound 2023; 26:479-486. [PMID: 36229757 PMCID: PMC10247913 DOI: 10.1007/s40477-022-00736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Suhel G Al Khayyat
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Giuseppe Fogliame
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Stefano Barbagli
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marta Fabbroni
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Roberto D'Alessandro
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Antonio Vitale
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Salvatore Massimo Stella
- Advanced Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, SIUMB School of Pisa, Santa Chiara University Hospital, Pisa, Italy
| | - Annarita Saponara
- Advanced Musculoskeletal Ultrasound, SIUMB School of San Giovanni Rotondo, Foggia, Italy
| | - Andrea Del Chiaro
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
- Orthopedic and Traumatology Operating Unit, San Luca Hospital, Lucca, Italy
| | - Paolo Falsetti
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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3
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Aktaş İ, Sarı K, Ünlü Özkan F, Nedim Kahraman A, Vural A, Akgün K. Magnetic resonance imaging/ultrasound fusion-guided sacroiliac joint corticosteroid injection in patients with axial spondyloarthritis. Turk J Phys Med Rehabil 2023; 69:116-120. [PMID: 37201011 PMCID: PMC10186019 DOI: 10.5606/tftrd.2022.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/04/2021] [Indexed: 05/20/2023] Open
Abstract
Local glucocorticoid injections are used in the treatment of isolated sacroiliitis in patients with spondyloarthritis. Sacroiliac joint injections can be performed intraarticularly or periarticularly. Since the accuracy of blind injections is low, fluoroscopy, magnetic resonance imaging, computed tomography, or ultrasonography guidance are used to increase the accuracy of sacroiliac joint injections. Currently, imaging fusion software is successfully used in sacroiliac joint interventions with three-dimensional anatomic information added to ultrasonography. Herein, we present two cases of sacroiliac joint corticosteroid injections under ultrasonography-magnetic resonance imaging fusion guidance.
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Affiliation(s)
- İlknur Aktaş
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Kemal Sarı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Feyza Ünlü Özkan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Nedim Kahraman
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Vural
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Kenan Akgün
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
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4
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Dejaco C, Machado PM, Carubbi F, Bosch P, Terslev L, Tamborrini G, Sconfienza LM, Scirè CA, Ruetten S, van Rompay J, Proft F, Pitzalis C, Obradov M, Moe RH, Mascarenhas VV, Malattia C, Klauser AS, Kent A, Jans L, Hartung W, Hammer HB, Duftner C, Balint PV, Alunno A, Baraliakos X. EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2022; 81:760-767. [PMID: 34893469 DOI: 10.1136/annrheumdis-2021-221261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). METHODS European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel. CONCLUSION These are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria
- Department of Rheumatology (ASAA-SABES), Brunico Hospital, Brunico, Italy
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Universita degli Studi di Milano, Milano, Italy
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology, St. Anna Hospital, Herne, Germany
| | - Jef van Rompay
- Patient Research Partners, Patient Research, Antwerpen, Belgium
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Marina Obradov
- Radiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rikke Helene Moe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Vasco V Mascarenhas
- UIME (Unidade de Imagem Musculo-esquelética), Hospital da Luz Imaging Center, Lisbon, Portugal
- Rheumatic Diseases Lab, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Andrea Sabine Klauser
- Radiology II, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Alison Kent
- Salisbury Hospital NHS Foundation Trust, Salisbury, UK
| | - Lennart Jans
- Radiology, Ghent University Hospital Radiology Department, Gent, Belgium
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany
| | - Hilde Berner Hammer
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
| | - Xenofon Baraliakos
- Rheumatology, Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Herne, Germany
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Ramírez Huaranga MA, Castro Corredor D, Plasencia Ezaine AE, Paulino Huertas M, Arenal Lopez R, Fernández JA, Ramos Rodríguez CC. First Spanish study on the effectiveness of ultrasound-guided sacroiliac joint injection in patients with spondylarthritis. Rheumatol Adv Pract 2022; 6:rkac036. [PMID: 35663153 PMCID: PMC9154057 DOI: 10.1093/rap/rkac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To assess clinical improvement after ultrasound-guided injection of corticosteroids into the sacroiliac joint of patients with spondyloarthritis.
Methods
Observational, descriptive, retrospective study of patients with spondyloarthritis and sacroiliitis who received an ultrasound-guided injection into the sacroiliac joint between June 1, 2020 and May 31, 2021. Means were compared using the t test for the variables VAS, BASDAI, ASDAS, CRP, and ESR before and after the procedure. We evaluated the association between these variables and the clinical response using the odds ratio.
Results
We 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 oedema resolved in 87.5% of cases compared with the previous magnetic resonance scan. No significant association was identified with the clinical response to the injection.
Conclusions
Ultrasound-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.
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Affiliation(s)
| | - David Castro Corredor
- Rheumatology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Marco Paulino Huertas
- Rheumatology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rocío Arenal Lopez
- Interventional Rheumatology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Urits I, Viswanath O, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:31915. [DOI: 10.52965/001c.31915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
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Truong SL, McEwan T, Bird P, Lim I, Saad NF, Schachna L, Taylor AL, Robinson PC. Australian Consensus Statements for the Assessment and Management of Non-radiographic Axial Spondyloarthritis. Rheumatol Ther 2021; 9:1-24. [PMID: 34962620 PMCID: PMC8814294 DOI: 10.1007/s40744-021-00416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background The understanding of non-radiographic axial spondyloarthritis (nr-axSpA) has accelerated over the last decade, producing a number of practice-changing developments. Diagnosis is challenging. No diagnostic criteria exist, no single finding is diagnostic, and other causes of back pain may act as confounders. Aim To update and expand the 2014 consensus statement on the investigation and management of non‐radiographic axial spondyloarthritis (nr-axSpA). Methods We created search questions based on our previous statements and four new topics then searched the MEDLINE and Cochrane databases. We assessed relevant publications by full-text review and rated their level of evidence using the GRADE system. We compiled a GRADE evidence summary then produced and voted on consensus statements. Results We identified 5145 relevant publications, full-text reviewed 504, and included 176 in the evidence summary. We developed and voted on 22 consensus statements. All had high agreement. Diagnosis of nr-axSpA should be made by experienced clinicians, considering clinical features of spondyloarthritis, blood tests, and imaging. History and examination should also assess alternative causes of back pain and related conditions including non-specific back pain and fibromyalgia. Initial investigations should include CRP, HLA-B27, and AP pelvic radiography. Further imaging by T1 and STIR MRI of the sacroiliac joints is useful if radiography does not show definite changes. MRI provides moderate-to-high sensitivity and high specificity for nr-axSpA. Acute signs of sacroiliitis on MRI are not specific and have been observed in the absence of spondyloarthritis. Initial management should involve NSAIDs and a regular exercise program, while TNF and IL-17 inhibitors can be used for high disease activity unresponsive to these interventions. Goals of treatment include improving the frequent impairment of social and occupational function that occurs in nr-axSpA. Conclusions We provide 22 evidence-based consensus statements to provide practical guidance in the assessment and management of nr-axSpA. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00416-7.
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Affiliation(s)
- Steven L Truong
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia.
- Coast Joint Care, Maroochydore, QLD, Australia.
| | - Tim McEwan
- School of Clinical Medicine, University of Queensland, Herston Rd, Herston, QLD, 4006, Australia
| | - Paul Bird
- St George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | | | - Nivene F Saad
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Lionel Schachna
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Andrew L Taylor
- Department of Rheumatology, Medical School, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Philip C Robinson
- Metro North, Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, QLD, 4006, Australia
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Bosch P, Carubbi F, Scirè CA, Baraliakos X, Falzon L, Dejaco C, Machado PM. Value of imaging to guide interventional procedures in rheumatic and musculoskeletal diseases: a systematic literature review informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2021-001864. [PMID: 34810228 PMCID: PMC8609947 DOI: 10.1136/rmdopen-2021-001864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To summarise current data on the value of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal disease (RMDs) informing an European Alliance of Associations for Rheumatology taskforce. METHODS A systematic literature review was conducted to retrieve prospective and retrospective studies published in English and comparing different (imaging) techniques, different settings and procedural protocols to guide interventions in patients with RMDs. MEDLINE, EMBASE, the Cochrane Library and Epistemonikos databases were searched through October 2021. Risk of bias (RoB) was assessed using the Cochrane RoB tool for randomised trials V.2 (ROB2), the RoB tool for Non-Randomised Studies of Interventions and the appraisal tool for cross-sectional studies. RESULTS Sixty-six studies were included (most with moderate/high RoB); 49 were randomised controlled trials, three prospective cohort studies and 14 retrospective studies. Fifty-one studies compared either one imaging technique with another imaging technique, or with palpation-guided interventions. Ultrasound (US) was most frequently studied (49/51), followed by fluoroscopy (10/51). Higher accuracy was found for US or fluoroscopy compared with palpation-guided interventions. Studies comparing different imaging techniques (12/51) did not endorse one specific method. Different settings/equipment for imaging-guided procedures (eg, automatic vs manual syringes) were investigated in three studies, reporting heterogeneous results. Fifteen studies compared different imaging-guided procedures (eg, intra-articular vs periarticular injections). CONCLUSION Higher accuracy of needle positioning at joints and periarticular structures was seen in most studies when using imaging (especially US) guidance as compared with palpation-guided interventions with the limitation of heterogeneity of data and considerable RoB.
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Affiliation(s)
- Philipp Bosch
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | | | | | | | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria .,Rheumatology Service, Hospital of Bruneck, Bruneck, Italy
| | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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9
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Buchanan P, Vodapally S, Lee DW, Hagedorn JM, Bovinet C, Strand N, Sayed D, Deer T. Successful Diagnosis of Sacroiliac Joint Dysfunction. J Pain Res 2021; 14:3135-3143. [PMID: 34675642 PMCID: PMC8517984 DOI: 10.2147/jpr.s327351] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Sacroiliac joint (SIJ) pain is one of the most common causes of low back pain, accounting for 15 to 30% of all cases. Although SIJ dysfunction accounts for a large portion of chronic low back pain prevalence, it is often overlooked or under diagnosed and subsequently under treated. The purpose of this review was to establish a best practices model to effectively diagnose SIJ pain through detailed history, physical exam, review of imaging, and diagnostic block. Methods A literature search was performed on the diagnosis of sacroiliac joint pain and sacroiliac joint dysfunction. The authors proposed diagnostic recommendations based upon the available literature and a detailed understanding of diagnosing SIJ pain. Results The practitioner must focus on the history, location of pain, observed gait pattern, and perform key points of the physical exam including sacroiliac provocative maneuvers. If the patient exhibits at least three provocative maneuvers then the SIJ may be considered as a possible source of pain. Additionally, a thorough review of the imaging should be performed to rule out other etiologies of low back pain. In the absence of any pathognomonic tests or examination findings, diagnostic SIJ blocks have evolved as the diagnostic standard. Conclusion The diagnosis of SIJ pain is a multifaceted process that involves a careful assessment including differentiating other pain generators in the region. This involves careful history taking, appropriate physical examination including provocative maneuvers and diagnostic injections. Once the diagnosis is confirmed, long-term solutions may be considered, including recent advances in sacral lateral branch denervation and sacroiliac joint fusion.
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Affiliation(s)
- Patrick Buchanan
- Department of Pain Medicine, Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA
| | - Shashank Vodapally
- Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - David W Lee
- Department of Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher Bovinet
- Department of Pain Medicine, The Spine Center of Southeast Georgia, Brunswick, GA, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Bessar AAA, Arnaout MM, Basha MAA, Shaker SE, Elsayed AE, Bessar MA. Computed tomography versus fluoroscopic guided-sacroiliac joint injection: a prospective comparative study. Insights Imaging 2021; 12:38. [PMID: 33738560 PMCID: PMC7973316 DOI: 10.1186/s13244-021-00982-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background There are limited data discussing long-term pain relief and comparability of different image-guided sacroiliac joint (SIJ) injection. This study compared CT and fluoroscopic-guided SIJ injections regarding statistically and clinically significant differences in numeric pain reduction, radiation doses, and patient’s satisfaction. Methods A prospective study conducted on 52 patients who met specific inclusion criteria of SIJ pain. A mixture of 1 ml of 40 mg methylprednisolone acetate diluted in 2 ml of lidocaine 2% was injected under either CT or fluoroscopic guidance. Numeric rating score (NRS) and Oswestry disability index (ODI) were assessed and recorded for each patient before procedure and one-week, and one-, three-, six-, and 12-months after procedure. The results were compared between both groups. Results Analysis of NRS one-month post-procedure showed a significant decrease from baseline in both groups: 12.5% in CT group (p = 0.002) and 9.5% in fluoroscopic group (p = 0.006). No significant difference in NRS between two groups at one- and three-months post-procedure (p = 0.11 and 0.1, respectively). There was a significant difference in NRS between two groups at six- and 12-months post-procedure (p = 0.001 and < 0.0001, respectively). Comparison of ODI at six-month post-procedure revealed that both groups had a statistically significant improvement (p < 0.0001). There was a significant difference in ODI between two groups at six-months post-procedure (p = 0.01). Conclusions CT-guided SIJ injection compares favorably with fluoroscopic guidance and offers statistically and clinically significant long-term pain relief. The use of dose reduction protocol in CT is important for decreasing the radiation dose.
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Affiliation(s)
- Ahmed A A Bessar
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed M Arnaout
- Department of Neurosurgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Shady E Shaker
- Department of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ashraf E Elsayed
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Manar Awad Bessar
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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11
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Aktas İ, Unlu Ozkan F, Sari K. Comment on "Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence?" by Wendling et al. Joint Bone Spine 2020; 87:209-213. Joint Bone Spine 2020; 88:105083. [PMID: 33115665 DOI: 10.1016/j.jbspin.2020.105083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- İlknur Aktas
- University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, PM&R Clinic , Istanbul, Turkey
| | - Feyza Unlu Ozkan
- University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, PM&R Clinic , Istanbul, Turkey
| | - Kemal Sari
- University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, PM&R Clinic , Istanbul, Turkey.
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12
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Bronsard N, Pelletier Y, Darmante H, Andréani O, de Peretti F, Trojani C. Sacroiliac joint syndrome after lumbosacral fusion. Orthop Traumatol Surg Res 2020; 106:1233-1238. [PMID: 32900669 DOI: 10.1016/j.otsr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION One-third of low back pain cases are due to the sacroiliac (SI) joint. The incidence increases after lumbosacral fusion. A positive Fortin Finger Test points to the SI joint being the origin of the pain; however, clinical examination and imaging are not specific and minimally contributory. The gold standard is a test injection of local anesthetic. More than 70% reduction in pain after this injection confirms the SI joint is the cause of the pain. The aim of this study was to evaluate the decrease in pain on a Numerical Rating Scale (NRS) after intra-articular injection into the SI joint. We hypothesised that intra-articular SI injection will significantly reduce SI pain after lumbosacral fusion. METHODS All patients with pain (NRS>7/10) suspected of being caused by SI joint syndrome 1 year after lumbosacral fusion with positive Fortin test were included. Patients with lumbar or hip pathologies or inflammatory disease of the SI joint were excluded. Each patient underwent a 2D-guided injection of local anesthetic into the SI joint. If this failed, a second 2D-guided injection was done; if this also failed, a third 3D-guided injection was done. Reduction of pain on the NRS by>70% in the first 2 days after the injection confirmed the diagnosis. Whether the injection was intra-articular or not, it was recorded. Ninety-four patients with a mean age of 57 years were included, of which 70% were women. RESULTS Of the 94 patients, 85 had less pain (90%) after one of the three injections. The mean NRS was 8.6/10 (7-10) before the injection and 1.7/10 after the injection (0-3) (p=0.0001). Of the 146 2D-guided injections, 41% were effective and 61% were intra-articular. Of the 34 3D-guided injections, 73% were effective and 100% were intra-articular. DISCUSSION This study found a significant decrease in SI joint-related pain after intra-articular injection into the SI joint in patients who still had pain after lumbosacral fusion. If this injection is non-contributive when CT-guided under local anesthesia, it can be repeated under general anesthesia with 3D O-arm guidance. This diagnostic strategy allowed us to confirm that pain originates in the SI joint after lumbosacral fusion in 9 of 10 patients. CONCLUSION If the first two CT-guided SI joint injections fail, 3D surgical navigation is an alternative means of doing the injection that helps to significantly reduce SI joint-related pain after lumbosacral fusion. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Nicolas Bronsard
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France.
| | - Yann Pelletier
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Hugo Darmante
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Olivier Andréani
- Radiology Unit, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Fernand de Peretti
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Christophe Trojani
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
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13
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Abstract
Drug treatment in patients with axial spondylarthritis (axSpA) aims to modify symptoms and complaints and currently includes the substance groups of nonsteroidal anti-inflammatory drugs (NSAID) and biologicals (disease-modifying antirheumatic drugs, bDMARDS). Treatment with NSAIDs is the first line treatment according to international and national recommendations. Patients with persisting high disease activity despite continuous standard treatment with NSAIDs, should be treated with biologicals. In Germany treatment with tumor necosis factor (TNF) inhibitors or interleukin 17 inhibitor (secukinumab) are currently approved for treating patients with ankylosing spondylitis (AS). Treatment of patients with non-radiographic axSpA (nr-axSpA) is restricted to TNF inhibitors (except infliximab) in Germany. The efficacy and safety are documented for both substance groups; however, due to the longer time since approval longitudinal data for TNF inhibitors are more robust and the data contain information about switching within a substance group. Although overall retention rates of TNF inhibitors are similar despite the difference in formation of antidrug antibodies, data from cohorts provide information about long-term loss of efficacy, switching and also discontinuation strategies. In the meantime, various biosimilars have been approved for infliximab, etanercept and adalimumab. Conventional basic treatment (csDMARDs) and in particular intra-articular administration of glucocorticoids can only be prescribed for axSpA patients with peripheral arthritis.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.,Ruhr-Universität Bochum, Bochum, Deutschland
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14
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Wei JCC, Liu CH, Tseng JC, Hsieh LF, Chen CH, Chen HH, Chen HA, Chen YC, Chou CT, Liao HT, Lin YC, Luo SF, Yang DH, Yeo KJ, Tsai WC. Taiwan Rheumatology Association consensus recommendations for the management of axial spondyloarthritis. Int J Rheum Dis 2019; 23:7-23. [PMID: 31777200 PMCID: PMC7004149 DOI: 10.1111/1756-185x.13752] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/31/2019] [Indexed: 12/16/2022]
Abstract
Aim To establish guidelines for the clinical management of axial spondyloarthritis that take into account local issues and clinical practice concerns for Taiwan. Method Overarching principles and recommendations were established by consensus among a panel of rheumatology and rehabilitation experts, based on analysis of the most up‐to‐date clinical evidence and the clinical experience of panelists. All Overarching Principles and Recommendations were graded according to the standards developed by the Oxford Centre for Evidence Based Medicine, and further evaluated and modified using the Delphi method. Results The guidelines specifically address issues such as local medical considerations, National Health Insurance reimbursement, and management of extra‐articular manifestations. Conclusion It is hoped that this will help to optimize clinical management outcomes for axial spondyloarthritis in Taiwan.
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Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hsiung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-An Chen
- Department of Allergy, Immunology, and Rheumatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Chou Chen
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology, Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chun Lin
- Department of Allergy, Immunology, and Rheumatology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jieh Yeo
- Division of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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15
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Xu J, Deng Y, Yu CY, Gao ZM, Yang XR, Zhang Q, Zhang L. Efficacy of wIRA in the treatment of sacroiliitis in male patients with ankylosing spondylitis and its effect on serum VEGF levels. J Orthop Surg Res 2019; 14:313. [PMID: 31533751 PMCID: PMC6749671 DOI: 10.1186/s13018-019-1322-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/16/2019] [Indexed: 12/04/2022] Open
Abstract
Background This study aimed to assess the efficacy of water-filtered infrared A (wIRA) in sacroiliitis in male patients with ankylosing spondylitis (AS) and the effect of wIRA therapy on serum vascular endothelial growth factor (VEGF). Methods One hundred twenty male AS patients with active sacroiliitis were randomly divided into wIRA group and control group. wIRA treatment was performed twice daily for 5 consecutive days with 24-h interval before switching the treatment (crossover design). Bath ankylosing spondylitis disease activity index (BASDAI) scores, pain visual analogue scale (VAS), and morning stiffness VAS were recorded prior to and after each treatment period. Additionally, C-reactive protein (CRP), serum VEGF, and resistance index (RI) of sacroiliac joints detected by ultrasonography were recorded at baseline and after the first and second treatment period, respectively. The efficacy was examined by using repeated measures analysis of variance (ANOVA). Results BASDAI, pain VAS, and morning stiffness VAS scores decreased significantly (P < 0.001) after wIRA treatment and no-wIRA treatment (control group), and the difference between the two groups was significant (P < 0.001). CRP declined and RI increased during the wIRA treatment as compared with the no-wIRA treatment (P < 0.001). The increase in RI was associated with improvement of pain VAS scores (P = 0.018), while serum VEGF was unaffected by the treatment. Conclusions wIRA treatment achieved symptom and pain relief for AS patients with active sacroiliitis. wIRA treatment also improved RI revealed by ultrasonography, and this effect was associated with improved pain VAS scores.
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Affiliation(s)
- Jian Xu
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China
| | - Yao Deng
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China
| | - Chun-Yan Yu
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China
| | - Zhao-Meng Gao
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China
| | - Xi-Rui Yang
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China
| | - Qi Zhang
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China
| | - Lei Zhang
- Department of Rheumatology and Immunology, Shengli Oilfield Central Hospital, No. 31 of Jinan Road, Dongying, 257034, Shandong, China.
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16
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Zheng P, Schneider BJ, Yang A, McCormick ZL. Image‐Guided Sacroiliac Joint Injections: an Evidence‐based Review of Best Practices and Clinical Outcomes. PM R 2019; 11 Suppl 1:S98-S104. [DOI: 10.1002/pmrj.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Patricia Zheng
- Department of Orthopaedic SurgeryUniversity of California San Francisco San Francisco CA
| | - Byron J. Schneider
- Department of Physical Medicine and RehabilitationVanderbilt University Nashville TN
| | - Aaron Yang
- Department of Physical Medicine and RehabilitationVanderbilt University Nashville TN
| | - Zachary L. McCormick
- Department of Physical Medicine and RehabilitationUniversity of Utah Salt Lake City UT
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17
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Wendling D. Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence? Joint Bone Spine 2019; 87:209-213. [PMID: 31216488 DOI: 10.1016/j.jbspin.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
Local sacroiliac injections represent an available treatment option in spondyloarthritis (SpA). There is no synthetic data about efficacy of this procedure in SpA. The aim of this review is to analyze the available data of the literature of local sacroiliac injections in SpA. METHODS A Pubmed search of papers published after 1990 was performed. RESULTS Pubmed search retained 15 publications in spondyloarthritis, 12 with corticosteroids (total of 468 injections in 268 patients), including 2 small-sized controlled studies, and 3 with TNF blockers (24 patients in open studies). With steroids, the two controlled studies (with a total number of 30 patients only) demonstrated significant results over placebo. In open studies, good response was reported in more than 80% of the cases, with a mean duration of improvement over 8 months. Reduction of sacroiliac inflammation on MRI was also found in several studies after injection. There is no consensus about the technique of injection or the type of steroid injected. No particular safety concern was reported. Many limitations have to be considered in the interpretation of these results. CONCLUSION This kind of procedure should be kept in the therapeutic armament in the current setting of costly targeted systemic treatments of spondyloarthritis. However, definition of a clear position in the treatment strategy needs further well-conducted studies.
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Affiliation(s)
- Daniel Wendling
- Department of Rheumatology, University Teaching Hospital, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4266, EPILAB, Université Bourgogne Franche-Comté, 25030 Besançon, France.
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18
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Navigating the Murk: Ethical and Practical Considerations for the Surgical Treatment of the Sacroiliac Joint Syndrome. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Chauhan G, Hehar P, Loomba V, Upadhyay A. A Randomized Controlled Trial of Fluoroscopically-Guided Sacroiliac Joint Injections: A Comparison of the Posteroanterior and Classical Oblique Techniques. Neurospine 2018; 16:317-324. [PMID: 30531656 PMCID: PMC6603830 DOI: 10.14245/ns.1836122.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The sacroiliac joint can be a primary source of pain or part of multifactorial syndromes. As there is no single historical, physical examination-based, or radiological feature that definitively establishes a diagnosis of sacroiliac joint pain, diagnostic blocks are regarded as the gold standard. The primary aim of this randomized trial was to compare the posteroanterior approach with the classic oblique approach for sacroiliac joint injection based on an assessment of procedure times and patient-reported pain outcomes in subjects scheduled for fluoroscopically-guided sacroiliac joint injections. METHODS Thirty patients were randomized into 2 groups of 15 patients each. The endpoints measured included the total length of procedure time, fluoroscopic time, needling time (length of time the needle was maneuvered), and pre- and postprocedure visual analogue scale pain scores. RESULTS The posteroanterior approach was significantly shorter in terms of procedure time (p=0.03) and needling time (p=0.01) than the oblique approach. Adjusting for body mass index, the mean procedure and needling times were significantly shorter in the posteroanterior group than in the oblique group. CONCLUSION This study of the posteroanterior approach for fluoroscopic-guided sacroiliac joint injection observed shorter times for fluoroscopy, needling, and the overall procedure than were recorded for the widely prevalent oblique approach. This may translate to lower radiation exposure, lower procedural costs, and enhanced ergonomics of fluoroscopicallyguided sacroiliac joint injections.
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Affiliation(s)
- Gaurav Chauhan
- Anesthesiology, Pain management, and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Prabhdeep Hehar
- Anesthesiology, Pain management, and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Vivek Loomba
- Anesthesiology, Pain management, and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Aman Upadhyay
- Anesthesiology, Pain management, and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
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20
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Mahmood F, Helliwell P. Ankylosing Spondylitis: A Review. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10314487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Ankylosing spondylitis is a chronic autoimmune inflammatory condition belonging to the spondyloarthropathy category of rheumatic diseases. It typically affects the axial skeleton but may also present with peripheral arthritis and extra-articular features. Ankylosing spondylitis tends to occur in patients under the age of 45 years, has a higher incidence in males, and can lead to disability and reduced quality of life if not adequately treated. Management consists of a multidisciplinary team approach. Although traditional disease modifying anti-rheumatic drugs are less effective for the axial component of this disease, biologic therapies do seem effective. In severe cases, surgery may be warranted.
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21
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Rouchy RC, Moreau-Gaudry A, Chipon E, Aubry S, Pazart L, Lapuyade B, Durand M, Hajjam M, Pottier S, Renard B, Logier R, Orry X, Cherifi A, Quehen E, Kervio G, Favelle O, Patat F, De Kerviler E, Hughes C, Medici M, Ghelfi J, Mounier A, Bricault I. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial. Trials 2017; 18:306. [PMID: 28683837 PMCID: PMC5501074 DOI: 10.1186/s13063-017-2049-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator's instruments, meaning the position and progression of the instruments are visualised in real time on the patient's images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. METHODS/DESIGN This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. DISCUSSION This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01896219 . Registered on 5 July 2013.
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Affiliation(s)
- R C Rouchy
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France. .,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France. .,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France. .,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.
| | - A Moreau-Gaudry
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), University Grenoble-Alpes, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre national de la recherche scientifique (CNRS), F-38000, Grenoble, France.,Pole Sante Publique, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - E Chipon
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - S Aubry
- Service de Radiologie Ostéo-Articulaire, Centre Hospitalier Universitaire (CHU) Besançon, F-25000, Besançon, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1431, F-25000, Besançon, France
| | - L Pazart
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1431, F-25000, Besançon, France
| | - B Lapuyade
- Service d'Imagerie Diagnostique et Therapeutique, Centre Hospitalier Universitaire (CHU) Bordeaux, F-33000, Bordeaux, France
| | - M Durand
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1401, F-33000, Bordeaux, France.,Centre d'Investigation Clinique (CIC) 1401, University Bordeaux, F-33000, Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Bordeaux, F-33000, Bordeaux, France
| | - M Hajjam
- Service de Radiologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-92100, Boulogne-Billancourt, France
| | - S Pottier
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1429, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-92380, Garches, France
| | - B Renard
- Service de Radiologie, Centre Hospitalier Universitaire (CHU) Lille, F-59000, Lille, France
| | - R Logier
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1403, Centre Hospitalier Universitaire (CHU) Lille, University Lille, F-59000, Lille, France
| | - X Orry
- Service de Radiologie, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, F-54000, Nancy, France
| | - A Cherifi
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique - Centre de technologie innovante (CIC-IT) 1433, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, F-54000, Nancy, France
| | - E Quehen
- Service Imagerie Abdominale et Générale, Centre Hospitalier Universitaire (CHU) Rennes, F-35000, Rennes, France
| | - G Kervio
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1414, Centre Hospitalier Universitaire (CHU) Rennes, F-35000, Rennes, France
| | - O Favelle
- Département Imagerie Médicale, Centre Hospitalier Universitaire (CHU) Tours, F-37000, Tours, France
| | - F Patat
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1415, Centre Hospitalier Universitaire (CHU) Tours, F-37000, Tours, France
| | - E De Kerviler
- Service de Radiologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75475, Paris, France
| | - C Hughes
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - M Medici
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - J Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - A Mounier
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - I Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), University Grenoble-Alpes, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre national de la recherche scientifique (CNRS), F-38000, Grenoble, France.,Pole Sante Publique, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
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22
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Akkoc N, Can G, D’Angelo S, Padula A, Olivieri I. Therapies of Early, Advanced, and Late Onset Forms of Axial Spondyloarthritis, and the Need for Treat to Target Strategies. Curr Rheumatol Rep 2017; 19:8. [DOI: 10.1007/s11926-017-0633-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract 2016; 17:782-791. [DOI: 10.1111/papr.12526] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/10/2016] [Accepted: 08/25/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Varun Singla
- Department of Anaesthesiology; Sanjay Gandhi Postgraduate Institute of Medical Sciences; Lucknow Uttar Pradesh India
| | - Yatindra K. Batra
- Department of Anaesthesiology; Max Super Speciality Hospital; Mohali Punjab India
| | - Neerja Bharti
- Department of Anaesthesia and Intensive Care; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Vijay G. Goni
- Department of Orthopaedics; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Neelam Marwaha
- Department of Transfusion Medicine; Post Graduate Institute of Medical Education and Research; Chandigarh India
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