Magnetic resonance imaging guided corticosteroid injection of sacroiliac joints in patients with spondylarthropathy. Are multiple injections more beneficial?

Abstract

Efficacy of a second magnetic resonance (MR) imaging guided corticosteroid injection of inflamed sacroiliac joints (SIJ) in patients with spondylarthropathy. Thirty-one patients received 50 injections in an outpatient basis. Fifteen of 31 patients who relapsed or were non-responders received a second injection. All had MR guided injection of 40 mg triamcinolone acetonide into SIJ using an open 0.2 Tesla unit. Twenty of 31 patients after the first injection, and 9 of 15 patients after the second injection reported subjective improvement, which lasted for a mean of 8.7+/-10.9 and 16.1+/-15.8 months for each group. Subchondral bone marrow edema resolved in 15 of 20 patients who reported subjective improvement, after the first injection. No complications occurred. MR guided steroid injection of SIJ is effective and safe. Since there is no exposure to radiation it could be performed many times. Repeated injections seem to be beneficial for primary non-responders and patients who relapsed.

Unguided sacroiliac injection: Effect on refractory buttock pain in patients with spondyloarthropathies

“…X-ray exposure must also be considered, especially since many patients with sacroiliitis are of reproductive age [15,16]. A new technique uses magnetic resonance imaging (MRI) to guide sacroiliac injections, and its results are similar to those with CT. Its main advantage is the absence of exposure to ionizing radiation [17,18]. But MRI is an expensive procedure and its use is limited in patients who are overweight [19], have particular types of phobia (claustrophobia) [20], and internal metallic implants (cardiac pacemakers, etc) [21].…”

CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months

“…These Bnon-responders^may be treated by repeated injection. In contrast to a systemic therapy, even multiple local injection treatment is not associated with systemic adverse events [35]. Menstrual period changes, as detected in our study, are tolerable and did not affect the acceptance of treatment.…”

“…Image guidance of SIJ injection seems to be essential for outcome and is done using different imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI), conventional fluoroscopy, and sonography, depending on local availability and the interventionalist's preference. The feasibility of different imaging modalities to monitor SIJ injection has been widely demonstrated, resulting in very high success rates of up to 90 % [8][9][10][11][12]. This study was designed to investigate the outcome of CT-guided sacroiliac corticosteroid injection therapy in patients with SpA and to identify potential reasons for treatment failure using a standardized approach.…”

An Imaging Review of Sacroiliac Joint Injection Under Computed Tomography Guidance

“…For inflammatory spondyloarthropathy, steroid injections relieved pain in 83% to 93% of patients in 3 of 4 studies. [6][7][8][9] For noninflammatory chronic SIJ arthralgia, serial SIJ steroid 10 or Hylan GF 20 (Synvisc) 11 injections can improve pain, disability, and work status.…”