BackgroundSacroiliac joint injection in axial spondyloarthritis (SpA) patients with steroid was controversial. A well designed randomized clinical trial testing its effect on different disease outcome measures particularly bone marrow edema was missing [1].ObjectivesTo test the effect of steroid injection in the sacroiliac joint of axial SpA patients on different disease outcome measures.MethodsN = 43 were registered. They were randomly assigned into 2 groups; Group I (23 cases) received sacroiliac joint injection lidocaine hydrochloride mixed with triamcinolone, whereas Group II (22 cases) received subcutaneous saline injections. All participants fulfilled the ASAS criteria for axial SPA and they all had bone marrow edema at baseline. Outcomes measures were: Visual Analogue Scale (VAS), ASDAS, BASFI, and SPARCC scores. Participants were assessed at baseline (before and after sacroiliac joint injection) and after 3 months.ResultsThere was a significant difference between both groups regarding pain, spine mobility, SPARCC and ASDAS scores in favor of group I. Spine mobility showed the earliest improvement, followed by pain whilst SPARCC and ASDAS scores showed improvement after 3 months. Higher disease activity, younger age, and shorter disease duration all were associated with better outcomes. Bilateral hip involvement was a predictor of poor responseConclusionSacroiliac joint injection of lidocaine and triamcinolone in axial SpA patients is effective in controlling pain, improving function, disease activity scores, and bone marrow edema with acceptable complications and relatively sustained effect.References[1]Elsaman, A., A. Hamed, and A. Radwan, Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. The Korean journal of pain, 2021. 34(1): p. 114.Table 1.Comparison between the two study groupsGroup I (N=24)Group II (N=23)P value*Age35.4±6.233.5±6.70.354SexMale17(77.3%)16(76.2%)1.000Female5(22.7%)5(23.8%)VASBefore injection (0)7.95±0.847.86±0.730.688After injection (1)3.55±1.446.95±1.02<0.00112 weeks later (2)4.82±1.377.19±0.81<0.001P value 0 vs 1**<0.0010.003-P value 0 vs 2**<0.0010.001-P value 1 vs 2**<0.0010.397-ASDASBefore injection2.69±0.442.60±0.370.45112 weeks later1.51±0.442.40±0.46<0.001P value **<0.0010.022BASFIBefore injection61.91±9.7062.95±11.710.75212 weeks later57.50±8.1361.24±0.530.199P value **<0.0010.081-SPARCCBefore injection34.73±9.1433.48±8.930.65212 weeks later15.68±6.6030.95±7.85<0.001P value **<0.0010.024-Finger to floorBefore injection (0)27.68±9.9426.90±11.620.815After injection (1)17.09±7.0025.48±11.230.00512 weeks later (2)19.64±7.8326.76±11.790.024P value 0 vs 1**<0.0010.001-P value 0 vs 2**<0.0010.791-P value 1 vs 2**0.0010.072-Lateral bendingBefore injection (0)21.64±5.9122.29±4.510.688After injection (1)25.50±6.1322.57±3.430.06012 weeks later (2)24.55±4.9522.24±2.950.071P value 0 vs 1**<0.0010.649-P value 0 vs 2**0.0030.947-P value 1 vs 2**0.0870.426-* p values were calculated using Independent t test, except for the sex, where Fisher Exact test was used.** p values for paired data was calculated using paired t test, to compare the baseline values (0) with either immediate post-injection (1) or 12 weeks later (2) values.Disclosure of InterestsNone declared
Objectives This study aimed at evaluating the effect of genicular nerve block (GNB) in juvenile idiopathic arthritis (JIA) patients with persistent unilateral knee arthritis on pain, inflammatory parameters, function, and range of motion. Methods A total of 104 JIA patients were diagnosed according to the International League Against Rheumatism (ILAR) criteria with persistent unilateral knee arthritis. They were allocated randomly into 2 groups: group 1 treated with GNB, while group 2 was treated with intra-articular triamcinolone (TA) only. Visual analogue scale (VAS) on pain, sonography of large joints in rheumatology (SOLAR) scoring system, and Lysholm scores were assessed at 0-, 2-, and 12-week intervals. Swelling and tenderness were clinically evaluated semi-quantitatively (0-3) at the same time intervals. Results VAS pain, tenderness, swelling, and SOLAR grey scale (GS) and power Doppler (PD) scores were significantly reduced after 2 weeks in both groups (p < 0.05). This was greater in the GNB group regarding VAS and tenderness, while SOLAR and swelling were stronger reduced in TA group. After 12 weeks, all outcome measures showed lower values in the GNB group compared to TA, and this was significant regarding VAS pain. Moreover, Lysholm functional score was significantly increased in both groups at both intervals; and higher values were seen in the TA group compared to GNB after 2 weeks. Conclusion GNB was able to control pain and improve function and inflammation of the knee joint in JIA patients. Though steroid attained better results after 2 weeks, GNB achieved an equivalent longer-term improvement after 12 weeks. Trial registration identifying number NCT04687930. Key Points• Persistent knee arthritis treatment in JIA is always challenging.• GNB was approved for treatment of pain in knee osteoarthritis.• GNB in the present study succeeded to control active knee arthritis and this effect was comparable to intra-articular steroid injection.
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