Kay-Geert A. Hermann MD, Presenter: Nothing to Disclose

Christian E. Althoff MD, Abstract Co-Author: Nothing to Disclose

Ulrike Thiess, Abstract Co-Author: Nothing to Disclose

Christian Nicholas H. Enzweiler MD, Abstract Co-Author: Nothing to Disclose

Gerd Diederichs MD, Abstract Co-Author: Nothing to Disclose

Bernd K. Hamm MD, Abstract Co-Author: Nothing to Disclose

Anatomy of the sacroiliac joints is complex. It is the major site of manifestation of spondyloarthritis (SpA, e.g. ankylosing spondylitis). Cortisone injections can alleviate symptoms caused by sacroiliitis but no systematic long-term data is available. This study prospectively evaluated the effectiveness of the slow-release glucocorticoid triamcinolone acetonide after computed tomography (CT) guided joint puncture in the treatment of sacroiliitis.

Forty-seven patients (21 men, 26 women) with known unilateral or bilateral sacroiliitis were administered 40 or 60 mg triamcinolone acetonide by means of CT-guided injection into the sacroiliac joint. Patients have been followed up for a total of 6 months so far. Symptoms and adverse events were evaluated by questionnaire, telephone interview, visual analogue scale (VAS; score of 0 to 10), and clinical examination once a day during the first week and then at monthly intervals. Patients were grouped according to whether the puncture cannula was in the joint or outside on CT fluoroscopy images obtained at the end of the intervention and evaluated by an independent reader.

The interventions were well tolerated. There were no serious complications. Forty patients (85%) stated that they would undergo the intervention again. The median VAS pain score of all patients decreased from 8.0 (6.6; 8.5) before therapy to 3.5 (quartiles: 2.0; 7.0) after 3 months (p=0.0001) and 6.0 (3.3; 8.0) after 6 months (p=0001). The score decreased from 8.0 (6.5; 8.5) to 5.0 (3.0; 8.0) (p=0.002) after 6 months in patients with intra-articular needle placement (79% of patients) and from 7.5 (6.2; 8.4) to 7.3 (6.0; 8.3) for extra-articular needle placement (not significant).

CT-guided corticoid injection of the sacroiliac joints is a reliable therapeutic option for treating SpA. Only intra-articular administration ensures significant pain reduction persisting for at least 6 months.

Our data shows that long-term effectiveness of intra-articular glucocorticoids crucially relies on adequate cannula placement, underlining the importance of image guidance (preferably by CT) of the procedure.

Hermann, K, Althoff, C, Thiess, U, Enzweiler, C, Diederichs, G, Hamm, B, CT-guided Corticoid Injection of the Sacroiliac Joints: Standardized Prospective Evaluation of Effectiveness and Quality Assurance.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5007023.html