Septic Sacroiliitis Following Corticosteroid Injection in a Patient Under Anti–Tumor Necrosis Factor Therapy

Rosenstock, Tizian; Hermann, Kay-Geert A.

doi:10.1097/rhu.0000000000000285

Cited by 4 publications

(3 citation statements)

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“…A review article reported that serious complications had not been reported after IA sacroiliac corticosteroid injection in 2007 34 ; since then, only a few cases of pyogenic sacroiliitis have been reported. 35,36 In a study of 191 IA sacroiliac glucocorticoid injections in 162 patients, the most common adverse effect was injection-site soreness (12.9%), followed by pain exacerbation (5.3%), vasovagal reaction (2.1%), facial flushing and/or sweating (2.3%), and steroid-clogged needle (0.5%). 37 Sacroiliitis is a common manifestation of AS, 3 and its treatment can be challenging.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Intra-articular Sacroiliac Glucocorticoid Injections in Ankylosing Spondylitis

Nam¹,

Kim²,

Lee

et al. 2020

J Clin Rheumatol

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Background/Aims: To assess the efficacy and safety of intra-articular sacroiliac glucocorticoid injection in ankylosing spondylitis (AS).Methods: Patients with AS undergoing fluoroscopy-guided intra-articular sacroiliac glucocorticoid injection were enrolled between 2012 and 2018. Efficacy was assessed by numeric pain rating scale, acute phase reactants, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Disease Activity Score (ASDAS). Patients who started biologics within 3 months despite the intervention were compared with those not starting biologics, hence: the nonbiologic group.Results: A total of 96 patients were treated, with a total of 107 injections.After intervention, there were significant decreases in numeric pain rating scale (7.8 ± 1.8 vs. 3.3 ± 2.2, p < 0.001) and acute phase reactants level (erythrocyte sedimentation rate [ESR] 23.0 mm/h [10.0-47.0 mm/h] vs. 13.0 mm/h [4.0-27.0 mm/h], p < 0.001; C-reactive protein [CRP] 1.0 mg/dL [0.2-2.7 mg/dL] vs. 0.2 mg/dL [0.2-0.9 mg/dL], p < 0.001). Disease activity scores also decreased for BASDAI (6.2 ± 1.8 vs. 4.5 ± 2.5, p = 0.001), Bath Ankylosing Spondylitis Functional Index (5.5 [4.1-7.0] vs. 1.8 [0.5-4.1], p = 0.001), ASDAS-CRP (2.9 ± 1.0 vs. 2.3 ± 1.3, p = 0.046), and ASDAS-ESR (3.7 ± 1.1 vs. 2.4 ± 1.3, p < 0.001). However, 12 patients (12.5%) started biologics within 3 months. These patients showed higher ESR (91.0 mm/h [IQR 21.0-113.0 mm/h] vs. 21.5 mm/h [IQR 9.5-43.0 mm/h], p = 0.010), CRP (8.0 mg/dL [IQR 1.11-17.1 mg/dL] vs. 0.8 mg/dL [IQR 0.2-1.8 mg/dL], p = 0.002), BASDAI (7.4 ± 1.2 vs. 5.9 ± 1.8, p = 0.027), and ASDAS-CRP (4.0 ± 0.5 vs. 2.8 ± 1.0, p = 0.004) than the nonbiologic group. There was no serious adverse event.Conclusions: Intra-articular sacroiliac glucocorticoid injection can be a safe and effective treatment option for active sacroiliitis in AS.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Intra-articular Sacroiliac Glucocorticoid Injections in Ankylosing Spondylitis

Nam¹,

Kim²,

Lee

et al. 2020

J Clin Rheumatol

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“…However, there are concordant results of many open studies, with high percentage of patients improved, and results lasting several months. This treatment option appears safe, but we have to bear in mind the possibility of septic arthritis after local sacro iliac corticosteroid injection for mechanical disease [23,24]. Some questions arise from these results.…”

Section: Commentsmentioning

confidence: 99%

Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence?

Wendling

2020

Joint Bone Spine

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“…Based on the causes of sacroiliitis, its treatment strategies and its prognosis are different. Common etiologies include sacroiliac arthritis ( 2 – 5 ), ankylosing spondylitis ( 6 – 8 ), osteitis condensans ilii ( 9 , 10 ), gout ( 11 , 12 ), osteoarthritis, tumors ( 13 ), septic arthritis ( 14 – 20 ), and brucellosis ( 21 – 26 ). Sacroiliitis is frequently a neglected diagnosis among clinicians especially when history taking and physical examination is done carelessly.…”

Section: Introductionmentioning

confidence: 99%

Frequency of sacroiliitis among patients with low back pain

Owlia¹,

Danesh-Ardakani²

2016

Electron physician

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IntroductionSacroiliitis is one of the important symptoms in patients attending infectious diseases and rheumatology clinics. Some patients with sacroiliitis are asymptomatic, and some have unspecific symptoms. The aim of this study was to determine the frequency of sacroiliitis causes among patients attending Shahid Sadoughi’s infectious disease and rheumatology clinics.MethodsIn this study, we evaluated patients attending Shahid Sadoughi rheumatology and infectious diseases clinic in 2014. Patients who had positive findings in favor of sacroiliitis were evaluated by history, physical exam, laboratory tests, and imaging. The patients were divided into infectious, inflammatory non-infectious, and degenerative causes. The data were analyzed by IBM SPSS version 20 using the independent samples t-test, ANOVA, the chi-squared test, and the Fisher’s exact test.ResultsWe studied 136 patients. Among them 64 (47.1%) were male, and 72 (52.9%) were female. The mean age of the participants was 34.28 ± 10.36 years. Among the patients, 12 (8.8%) had infectious causes, 120 (88.2%) had inflammatory non-infectious causes, and four (2.9%) had degenerative causes.ConclusionBased on our results, inflammatory non-infectious causes are at the top of the list of sacroiliitis causes, but we should always consider infectious causes, including brucellosis.

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Septic Sacroiliitis Following Corticosteroid Injection in a Patient Under Anti–Tumor Necrosis Factor Therapy

Cited by 4 publications

References 3 publications

Efficacy and Safety of Intra-articular Sacroiliac Glucocorticoid Injections in Ankylosing Spondylitis

Efficacy and Safety of Intra-articular Sacroiliac Glucocorticoid Injections in Ankylosing Spondylitis

Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence?

Frequency of sacroiliitis among patients with low back pain

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