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

Local sacroiliac injections represent an available treatment option in spondyloarthritis (SpA). There is nosynthetic data about efficacy of this procedure in SpA. The aim of this review is to analyze the availabledata 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 of468 injections in 268 patients), including 2 small-sized controlled studies, and 3 with TNF blockers (24patients in open studies). With steroids, the two controlled studies (with a total number of 30 patientsonly) demonstrated significant results over placebo. In open studies, good response was reported inmore than 80% of the cases, with a mean duration of improvement over 8 months. Reduction of sacroiliacinflammation on MRI was also found in several studies after injection. There is no consensus about thetechnique of injection or the type of steroid injected. No particular safety concern was reported. Manylimitations 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 ofcostly targeted systemic treatments of spondyloarthritis. However, definition of a clear position in thetreatment strategy needs further well-conducted studies. (c) 2019 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.