What corticosteroids can be used for sacroiliac joint injection?

Comment by InpharmD Researcher

Available evidence on corticosteroid injections into the sacroiliac joint (SIJ) primarily support the use of methylprednisolone and triamcinolone acetonide. Multisocietal consensus recommendations note that intra-articular and extra-articular SIJ corticosteroid injections provide short-to-intermediate-term pain relief (1-3 months); however, most recommendations are derived from studies in large-joint injections as most of the primary literature on SIJ corticosteroid injections is limited by small sample sizes, non-randomized designs, and concomitant administration of local anesthetics. The data support methylprednisolone 40 mg or triamcinolone acetonide 40 mg for SIJ injection, or equivalent doses of other agents (e.g., betamethasone 7.5–8 mg or dexamethasone 7.5 mg). Pooled analyses in non-spondyloarthroplastic SIJ pain revealed significant reductions in visual analog scale (VAS) pain scores at 2–6 months and >6 months follow-up, but optimal agent selection/dosing was inconclusive; for spondyloarthroplastic SIJ pain, pooled analyses mostly evaluating triamcinolone acetonide and methylprednisolone showed significant VAS reductions at short-term and mid-term follow-up, with worsening at final follow-up of at least 6 months.

steroids corticosteroids intra-articular sacroiliac joint injection

Background

A 2026 multisociety, multispecialty consensus guidance sponsored by the American Society of Regional Anesthesia and Pain Medicine utilized a modified Delphi process to develop recommendations for intra-articular and extra-articular sacroiliac joint (SIJ) corticosteroid injections. Both intra-/extra-articular SIJ corticosteroid injections provide short-/intermediate-term pain relief of 1–3 months (moderate level of certainty), expected to be observed in about half of patients meeting clinical criteria. Extra-articular or combined approaches are at least as effective as intra-articular injection alone (low level of certainty). These recommendations, however, are largely based on studies with small sample sizes, and no dose-finding studies in SIJ injections were identified. Extrapolating from corticosteroid data in large-joint injection studies and a retrospective comparison showing methylprednisolone 40 mg to be as effective as methylprednisolone 80 mg, the panel deemed reasonable either methylprednisolone 40 mg or triamcinolone 40 mg or equivalent doses of other agents, such as betamethasone 7.5–8 mg or dexamethasone 7.5 mg (grade I strength of recommendation). Particulate or non-particulate agents may be used (grade C strength of recommendation), although nearly all published data involve particulate formulations. Clinicians are recommended to withhold repeat injections until recurrence of joint pain to >50% of baseline (grade A strength of recommendation), within a 200 mg methylprednisolone-equivalent annual cap. Additionally, risks of SIJ corticosteroid injections are dose-dependent and include local and systemic infection, immunosuppression, hyperglycemia, decreased bone mineral density and increased fracture risk, and adrenal suppression in susceptible patients (moderate level of certainty). [1]

A 2024 systematic review and meta-analysis of 43 studies published through January 2023 and representing 2,431 adult patients with SIJ pain evaluated outcomes associated with injective therapies. This analysis excluded studies on spondyloarthroplasty and autoimmune diseases; among the included studies, only 5 were randomized controlled trials (RCTs), and most were case reports/series. Corticosteroids, typically combined with local anesthetic and injected intra-articularly under fluoroscopy, were examined in 63% of studies (n= 1,425 patients; mean age 50.4 years, mean body mass index [BMI] 30.2 kg/m2). SIJ injections of corticosteroids carried a 26% failure rate and a 1% complication rate. A pooled analysis of 11 corticosteroid studies (6 using triamcinolone acetonide, 4 using methylprednisolone, and 1 using betamethasone) showed significant visual analog scale (VAS) pain score reductions of 3.4 points at mid-term (2–6 months) and 3.0 points at long-term (>6 months) follow-up (both p<0.05). Only 1 included non-randomized study addressed corticosteroid agent selection for SIJ injection, concluding that both methylprednisolone and triamcinolone acetonide were comparable in efficacy at 1 month. Despite the good/fair quality of evidence ratings, results were limited by heterogeneous outcome measures, inconsistent follow-up rates, scarce randomized trial data, and very limited available data specific to agent selection and dosing/injection approach. [2]

A 2025 systematic review and meta-analysis of 17 studies published through January 2024 and representing 494 patients with spondyloarthroplasty-related SIJ pain evaluated outcomes of injective therapies, including corticosteroids and biologics. Intra-articular, mostly image-guided, corticosteroid injections were assessed in 15 studies (375 patients) using triamcinolone acetonide (9 studies), methylprednisolone (2 studies), betamethasone (2 studies), or cortivazol (2 studies) at volumes of 1–3 mL. Pooled VAS fell from a baseline of 7.0 to 3.2 at short-term follow-up and 3.3 at mid-term follow-up, then worsening to 5.1 at the final follow-up of at least 6 months (all p<0.001). The pooled failure rate was 13% (p= 0.019), and complications occurred in only 1 study (3 events for a total rate of 12.5%, all transient). The analysis concluded that intra-articular corticosteroid injections are effective and safe for SIJ pain in spondyloarthroplasty patients, although efficacy diminishes over time and not all patients respond to treatment. [3]

Background References: [1] Benzon HT, Doshi TL, Maus T, et al. Multisociety multispecialty consensus recommendations on corticosteroid injections for facet joint and sacroiliac joint pain. Reg Anesth Pain Med. Published online January 27, 2026. doi:10.1136/rapm-2025-107347
[2] Ruffilli A, Cerasoli T, Barile F, et al. Injective treatments for sacroiliac joint pain: a systematic review and meta-analysis. Indian J Orthop. 2024;58(6):637-649. doi:10.1007/s43465-024-01164-w
[3] Cerasoli T, Filardo G, Favero A, Rinaldi VG, Di Maio L, Marcheggiani Muccioli GM, Zaffagnini S. Injective Therapies for Managing Sacroiliac Joint Pain in Spondyloarthropathy: A Systematic Review and Meta-Analysis. J Clin Med. 2025 Feb 15;14(4):1294. doi:10.3390/jcm14041294
Literature Review

A search of the published medical literature revealed 6 studies investigating the researchable question:

What corticosteroids can be used for sacroiliac joint injection?

Level of evidence

A - Multiple high-quality studies with consistent results  Read more→


Please see Tables 1-6 for your response.

 

Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy

Design

Randomized, double-blind, controlled study

N= 20

Objective

To evaluate the efficacy of periarticular corticosteroid injection of the sacroiliac joint (SIJ) in patients with seronegative spondylarthropathy

Study Groups

Methylprednisolone (n= 10)

Non-methylprednisolone (n= 10)

Inclusion Criteria

Age 18 - 60 years; pain for at least one month in the SIJ; tenderness in the SIJ; positive results on at least two of the following tests: Gaenslen’s test, Patrick’s test, and/or thigh flexion test; stable treatment with disease modifying drugs and oral corticosteroids; no allergy to lidocaine

Exclusion Criteria

Include relevant exclusion criteria (not a comprehensive list).

Methods

This is our most important section. Data collection and any other information needed to understand the results is presented. Any loose ends from all other sections are tied up here, as concisely as possible.

Duration

Not specified

Outcome Measures

Adult patients with seronegative spondylarthropathy and clinical sacroiliitis were randomized into two groups. One group received 1.5 mL (40 mg/mL) methylprednisolone acetate and 1.5 mL (20 mg/mL) lidocaine, and the other group received 1.5 mL isotonic sodium chloride and 1.5 mL (20 mg/mL) lidocaine. Clinical assessment included visual analog scale (VAS) pain scores and pain index at baseline and after two months.

Baseline Characteristics

  

Methylprednisolone (n= 10)

 Control (n= 10)

Age, years

 42 ± 10 40 ± 11

Female

60% 30%

Bilateral radiological sacroiliitis

 70% 80%
Duration of spondylarthropathy, years 9 ± 6 6 ± 7
Duration of pain in SIJ, months 12 ± 11 12 ± 10
Erythrocyte sedimentation rate, mm/h 13 ± 7 20 ± 15
C-reactive protein, mg/L 9 ± 2 15 ± 13
Hemoglobin, g/dL

136 ± 12

 140 ± 10

Results

   Median (range) at baseline

Median (range) change at month 2
  Methylprednisolone (n= 10)

Control (n= 10)

 Methylprednisolone (n= 10) Control (n= 10)

VAS

54.5 (22 to 88)

 38.5 (4 to 52) 0.02 (-82 to 13) -26.5 (-47 to 38)
p= 0.02 p= 0.02
Pain index of sacroiliac joint

7.5 (4 to 9)

 6 (3 to 8)  0.10 (-7 to 0) -4.5 (-4 to 2)
p= 0.10 p= 0.01

Adverse Events

Not specified

Study Author Conclusions

The periarticular injection of methylprednisolone may be effective in the treatment of clinical sacroiliitis in patients with seronegative spondylarthropathy.

InpharmD Researcher Critique

The study suggests that periarticular corticosteroid injections can be effective for sacroiliitis, but the small sample size and preliminary nature of the results limit the generalizability. The study did not specify adverse events, which is a limitation in assessing the safety profile of the treatment.



Table 1 References:
[4] Luukkainen R, Nissil M, Asikainen E, et al. Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy. Clin Exp Rheumatol. 1999;17(1):88-90.

Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint
Design

Double blind, controlled study in Finland

N= 24
Objective

To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ
Study Groups

Methylprednisolone group (n= 13)

Non-methylprednisolone group (n= 11)
Inclusion Criteria

Age 18-70 years; pain at least for 3 months in the region of the SIJ; tenderness in the SIJ; positive results on at least one of the following tests: Gaenslen’s test, Patrick’s test or thigh flexion test; no allergy to lidocaine; no signs of infections or neoplasms; no radiological signs of sacroilitis and no signs of spondylarthropathy
Exclusion Criteria Signs of infections or neoplasms; radiological signs of sacroilitis; signs of spondylarthropathy
Methods

Patients were randomized into two groups. Thirteen patients received a periarticular injection of 1.5 mL (40 mg/mL) methylprednisolone acetate and 1.5 mL (20 mg/mL) lidocaine. Eleven patients received 1.5 mL isotonic sodium chloride and 1.5 mL (20 mg/mL) lidocaine. Clinical assessment included the patient’s estimation of pain in the region of the SIJ by the visual analogue scale (VAS) and by a pain index, which represented the sum of tenderness and stressing tests on the SIJ.
Duration

One month follow-up
Outcome Measures VAS and pain index improvement
Baseline Characteristics  

Methylprednisolone (n= 13)

 Non-methylprednisolone (n= 11)
Age, years (range) 50.3 (38 - 68) 49.3 (32 - 70)
Female 77% 64%
Duration of SIJ pain, years (range) 5.4 (0.3 - 15) 4.4 (0.3 - 11)
Number of patients with C-related protein less than 10 mg/L 100% 100%
Hemoglobin, g/L (range) 138 (121-155) 139 (119-162)
NSAID medication 77% 73%
Results  

Methylprednisolone (n= 13)

 Non-methylprednisolone (n= 11) p-value
VAS change -40 -13 0.046
Pain index change -3 0 0.017
Adverse Events Not reported
Study Author Conclusions

Periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.
Critique

The study suggests potential efficacy of periarticular corticosteroid treatment for SIJ pain in non-spondylarthropathic patients, but the small sample size and short follow-up period limit the generalizability and robustness of the findings. Further studies with larger sample sizes and longer follow-up are needed to confirm these preliminary results.

 

Table 2 References:
[5] Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002;20(1):52-54.

Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain
Design

Prospective, randomized, open blinded end point study

N= 40
Objective

To assess the efficacy and safety of platelet-rich plasma (PRP) compared with methylprednisolone in ultrasound-guided sacroiliac joint (SIJ) injection for low back pain
Study Groups

Group S (methylprednisolone) (n= 20)

Group P (PRP) (n= 20)
Inclusion Criteria

Patients aged 18-65 years with chronic low back pain below the L5 vertebra for >3 months, unilateral SIJ pathology on imaging, and 3 or more positive provocative tests
Exclusion Criteria

Systemic or localized infection, spinal pathology impeding recovery, history of intervertebral disk disease, pregnancy, active radicular pain, immunosuppressive conditions, allergy to medications used, narcotic use >60 mg morphine daily, contraindications to platelet concentrate
Methods

Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline. Group P received 3 mL of leukocyte-free PRP with 0.5 mL of calcium chloride. Injections were ultrasound-guided into the SIJ. Visual analog scale (VAS) pain score, Modified Owestry Disability Questionnaire (MODQ), and Short Form (SF-12) health survey scores were evaluated at 2 weeks, 4 weeks, 6 weeks, and 3 months.
Duration

Follow-up at 2 weeks, 4 weeks, 6 weeks, and 3 months
Outcome Measures

Primary: Reduction in VAS score

Secondary: Improvement in MODQ and SF-12 scores
Baseline Characteristics  

Group P (n= 20)

 Group S (n= 20)
Age (years) 35.20 ± 12.86 37.00 ± 10.89
Height (cm) 164 ± 6.00 166 ± 7.00
Weight (kg) 61.95 ± 12.22 61.1 ± 7.55
Body mass index (kg/m2) 23.69 ± 2.54 22.41 ± 2.08
Sex (M:F) 16:4 16:4
American Society of Anesthesiologists grade (I:II) 18:2 20:0
SIJ sidewise distribution (R:L) 6:14 6:14

Cause of pain

Ankylosing spondylitis

Trauma

Idiopathic

Degenerative

 

10 (50%)

7 (35%)

3 (15%)

0

 

8 (40%)

8 (40%)

2 (10%)

2 (10%)
Sacral tenderness 10 (50%) 9 (45%)
Results Median (IQR) VAS scores

Group P (n= 20)

 Group S (n= 20) p-value

Pre-injection

 7.5 (5 to 8) 6 (5 to 7) 0.132

2 weeks

 3 (0 to 5) 3 (2 to 3) 0.706

4 weeks

 1.5 (1 to 3) 3 (2 to 4) 0.054

6 weeks

 1 (1 to 1) 3.5 (2 to 5) 0.0004

3 months

 1 (1 to 3) 5 (3 to 5) 0.0002
Adverse Events

Post-injection pain and stiffness were higher in Group P (45% vs 5%; p= 0.008), but no major complications were observed in either group.
Study Author Conclusions

The intra-articular PRP injection is an effective treatment modality in low back pain involving SIJ, showing greater and longer-lasting pain relief compared to steroid injections.
Critique

The study's strengths include its randomized design and use of ultrasound guidance for injections. However, the open-label nature and short follow-up period of 3 months limit the ability to assess long-term efficacy and safety. Additionally, the study did not evaluate laboratory parameters that could provide insights into the pathophysiological effects of the treatments.

 

Table 3 References:
[6] Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017;17(6):782-791. doi:10.1111/papr.12526

Ultrasound-guided intra-sacroiliac joint injection — methylprednisolone versus triamcinolone: a randomized comparative study
Design

Prospective, single-center, randomized, double-blinded, comparative study

N= 90
Objective

To compare the effectiveness of ultrasound-guided intra-articular sacroiliac joint (SIJ) injection of methylprednisolone vs triamcinolone acetonide according to postinjection pain relief, the random blood glucose (RBG) level in diabetic patients, quality of life (QoL), patient’s satisfaction, and the analgesic requirement
Study Groups

Methylprednisolone group (n= 45)

Triamcinolone group (n= 45)
Inclusion Criteria

Age between 50 and 70 years; sacroiliac pain with at least 3 positive tests of the 5 provocative tests; pain not alleviated by conservative therapy for 4 weeks; positive diagnostic test with intra-articular SIJ injection with 2 mL lidocaine 2% 1 day before the procedure
Exclusion Criteria

Patient’s refusal, history of immunosuppression diseases, bleeding disorders, septic joint, local skin infection, renal patients (serum creatinine > 1.8 mg/dL), osteomyelitis, local malignancy, decompensated liver diseases, previous history of chronic opioid use, psychiatric disorders affecting cooperation, intra-articular sacroiliac injection within previous 3 months, hypersensitivity or allergy to study medications, negative diagnostic test, morbid obesity, and diabetes mellitus (type 2 with history of poor glycemic control)
Methods

Patients were randomly allocated into two groups. The methylprednisolone (MTP) group received ultrasound-guided intra-articular sacroiliac injection with 2 mL of 2% lidocaine hydrochloride and 40 mg of methylprednisolone. The triamcinolone (TMC) group received the same with 40 mg of triamcinolone acetonide. The procedure was performed under ultrasound guidance with a 22-G spinal needle. Heart rate, blood pressure, and saturation were monitored. If numerical rating scale (NRS) pain score was ≥ 4, NSAID in the form of 20 mg piroxicam was given once daily after meal to control the pain.
Duration Not stated
Outcome Measures

Primary: NRS at rest and during motion

Secondary: RBG level in diabetic patients, QoL using EQ‐5D‐5L, patient’s satisfaction, analgesic requirement
Baseline Characteristics   MTP group (n= 45)

TMC group (n= 45)
Mean age (years) 59.11 ± 7.33 61.47 ± 6.91
Female 71.1% 73.3%
Mean body mass index (kg/m2) 31.59 ± 4.20 32.08 ± 3.63
Mean disease duration (months) 19.11 ± 12.33 17.47 ± 12.12
Diabetic patients 51.1% 42.2%
Side - Right 31.1% 37.8%
Side - Left 68.9% 62.2%
Results Median (range) MTP group (n= 45)

TMC group (n= 45)

 p-value
NRS at rest at 2 weeks 3 (2–3) 4 (3–5) 0.025
NRS at motion at 2 weeks 4 (3–5) 5 (3–6) 0.036
RBG level 1 day after injection 206 (168–308) 170 (136–271) 0.066
RBG level 2 days after injection 245 (200–385) 168 (119–233) 0.045
RBG level 3 days after injection 215 (179–343) 166 (110–253) 0.049

There was no statistically significant difference in the QoL in all domains of EQ‐5D‐5L questionnaire between the two groups before and after injection. However, there was a statistically significant improvement in all domains of the QoL before and after injection in both groups (p< 0.001). 

There was no statistically significant difference in the patient satisfaction between the two groups.

There was no statistically significant difference in the analgesic requirement between the two groups (24.4% in MTP group and 20% in TMC group), while in each group the analgesic requirement was decreased (MTP p= 0.0254, TMC p= 0.0098).
Adverse Events

No specific adverse events reported
Study Author Conclusions

SIJ injection with methylprednisolone or triamcinolone acetonide showed an improvement in pain score, while the MTP group was better in NRS at 2 weeks. Also, the RBG level in diabetic patients was higher in the MTP group in the 1st, 2nd, and 3rd days after injection. There was upgrading in QoL, similarity in patient’s satisfaction, and reducing the use of analgesia with no statistically significant difference between the studied groups.
Critique

The study provides valuable insights into the comparative effectiveness of methylprednisolone and triamcinolone for SIJ injections. The strengths include a randomized double-blinded design and the use of ultrasound guidance. However, the study is limited by its relatively small sample size and short follow-up duration. Additionally, the lack of long-term outcomes and potential variability in ultrasound technique could affect the generalizability of the results.

 

Table 4 References:
[7] Ghaly EKE, Attia AA, Zagloul AAE, et al. Ultrasound-guided intra-sacroiliac joint injection - methylprednisolone versus triamcinolone: a randomized comparative study. Ain-Shams J Anesthesiol. 2023;15(31). doi:10.1186/s42077-023-00330-w

Under what conditions is the intra-articular steroid injection superior to nonsteroidal anti-inflammatory drugs for treating sacroiliac joint pain?
Design

Prospective, single-center study

N= 60
Objective

To determine the conditions under which intra-articular injection therapy may be superior to nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with sacroiliac joint (SIJ) pain in the outpatient setting
Study Groups

NSAID (n= 30)

Sacroiliac injection (n= 30)
Inclusion Criteria

Patients with localized sacroiliac pain, evaluated with lumbar and sacroiliac magnetic resonance imaging (MRI)
Exclusion Criteria

Patients with extruded disc herniation, uncorrected spondylolisthesis, radicular pain, neurological deficits, immunosuppression, osteoporosis, prior sacral surgery, negative effects from NSAIDs or steroids, previous gastric surgery or gastric ulcer, gastritis, and cancer
Methods

Patients were divided into two groups: NSAID group received 25 mg of indomethacin and 750 mg of naproxen orally once a day, and the sacroiliac injection group received 5 mg of betamethasone injected into the SIJ under fluoroscopy or ultrasound. Visual analog scale (VAS) pain scores were evaluated at week 1 and month 1.
Duration 2020 to 2022
Outcome Measures

Primary: Reduction in VAS scores

Secondary: Comparison of VAS score reduction in subgroups (sacroiliitis, lumbar surgery, duration of pain)
Baseline Characteristics   NSAID (n= 30)

Sacroiliac Injection (n= 30)
Female 16 (53.3%) 16 (53.3%)
Mean age (range) 59.9 (41-71) 60.5 (43-74)
Duration of pain >30 days 18 (60.0%) 17 (56.7%)
Sacroiliitis on MRI 12 (40%) 12 (40%)
Lumbar surgery 14 (46.6%) 10 (33.3%)
Mean baseline VAS 7.07±0.82 6.70±0.98
Results  

NSAID (n= 30)

 Sacroiliac Injection (n= 30) p-value
1-week VAS

5.60±0.96

 3.07±1.23 <0.001
1-month VAS

4.0±1.44

 1.93±1.01 <0.001

There were significant reductions observed in 1-week VAS and 1-month VAS in both the lumbar surgery and sacroiliitis subgroups.
Adverse Events Not reported
Study Author Conclusions

Intra-articular steroid injection is superior to NSAIDs for pain relief in patients with SIJ pain lasting more than 30 days, those with MRI-diagnosed sacroiliitis, and those who have undergone lumbar surgery.
Critique

The study provides strong evidence for the efficacy of sacroiliac joint injections over NSAIDs in specific patient groups. However, the small sample size and lack of long-term follow-up limit the generalizability of the findings. Additionally, the study did not explore potential side effects of the treatments in detail.

 

Table 5 References:
[8] Cine HS, Uysal E, Demirkol M, Cetin E. Under what conditions is the intra-articular steroid injection superior to nonsteroidal anti-inflammatory drugs for treating sacroiliac joint pain? Eur Rev Med Pharmacol Sci. 2023;27(21):10539-10546. doi:10.26355/eurrev_202311_34331

Ultrasound Guided Corticosteroids Sacroiliac Joint Injections (SIJIs) in the Management of Active Sacroiliitis: A Real-Life Prospective Experience

Design

Prospective, observational, real-life, single-center, non-randomized study

N= 46 (47 joints injected in the SIJI group)

Objective

To establish the efficacy of ultrasound (US)-guided corticosteroid sacroiliac joint infiltrations (SIJIs) in the treatment of active sacroiliitis in axial spondyloarthritis (axSpA)

Study Groups

US-guided SIJI (n= 26; 47 joints)

Controls starting or switching to biological disease-modifying drugs (bDMARDs, n= 20)

Inclusion Criteria

axSpA with active sacroiliitis documented via magnetic resonance imaging (MRI)

Exclusion Criteria

Stage IV sacroiliitis according to the modified New York criteria

Methods

SIJI group received a single injection of triamcinolone acetonide 40 mg (1 mL) per joint under US guidance (MyLabTwice, convex array 1–8 MHz); both SIJs were injected when indicated by clinical and radiological findings. Control group consisted of arthritis clinic patients with axSpA starting (or switching to) bDMARDs and already on NSAIDs.

Pain visual analog scale (VAS) score and morning stiffness (MS, in minutes) were collected at baseline, 24 h, 48 h (VAS only), weeks 1, 2, and 4, then monthly to 6 months. Weekly NSAID intake (tablets/week) was also recorded in the SIJI group.

Duration

Intervention: single US-guided SIJI

Follow-up: 6 months (24 weeks)

Outcome Measures

Change in pain VAS from baseline; change in MS (minutes) from baseline; change in weekly NSAID intake (SIJI group); adverse effects

Baseline Characteristics

 

SIJI (n= 26)

Controls (n= 20)

p-value

Age, years

52.35 ± 15

57.65 ± 11

NS

Female

25 (96%)

9 (45%)

-

Disease duration, months

75.82 ± 123

109.2 ± 71

<0.05

NSAID use

bDMARD use

>95%

15

>95%

20 (100%)

-

-

Baseline VAS pain

7.97 ± 1.25

8.05 ± 1.68

NS

Baseline MS, minutes

41.35 ± 20.52

45.75 ± 12.06

NS

Results

 

SIJI (n= 26)

Controls (n= 20)

p-value

VAS pain change at 24 h

-48%

No significant change

<0.0001 (SIJI vs baseline)

VAS pain change at 14 days (peak effect)

-61%

No significant change

<0.0001 (SIJI vs baseline)

First significant VAS reduction vs baseline

24 h (significant at every follow-up)

Week 12

<0.0001 (SIJI); <0.05 (controls)

VAS pain change at 6 months

-33%

Significant reduction (magnitude NR)

<0.0001 (SIJI vs baseline)

First significant MS reduction vs baseline

Week 1

Week 12

<0.0001 (SIJI); 0.003 (controls)

MS change at 6 months

-64%

Significant reduction (magnitude NR)

<0.0001 (SIJI vs baseline)

Weekly NSAID intake

Significantly reduced at weeks 1, 2, and 4

Not assessed

<0.001 (week 1); <0.05 (weeks 2 and 4)

The significant between-group difference in VAS pain was lost by month 5. 

Adverse Events

No significant side effects detected.

Study Author Conclusions

US-guided SIJI represents an effective and safe technique for patients who have active sacroiliitis yet are ineligible for biologic treatment or who experience unsatisfactory disease control despite receiving therapy.

Critique

Strengths include MRI-confirmed active sacroiliitis, a standardized triamcinolone 40 mg dose, a single operator, and frequent assessments over 6 months, which show onset within 24 hours, peak benefit at about 2 weeks, and partial waning thereafter. However, the small, nearly all-female, non-randomized cohort lacked a placebo or sham arm, intra-articular placement was not confirmed, and about half of injected patients were on concurrent bDMARDs, so the findings support triamcinolone 40 mg as a rapid bridging option rather than establishing its independent efficacy.

 

Table 6 References:
[9] Al Khayyat SG, Fogliame G, Barbagli S, et al. Ultrasound guided corticosteroids sacroiliac joint injections (SIJIs) in the management of active sacroiliitis: a real-life prospective experience. J Ultrasound. 2023;26(2):479-486. doi:10.1007/s40477-022-00736-6