Clinical and radiographic response to a local infliximab injection in a patient with chronic sacroiliitis.
BACKGROUND
A 49-year-old man presented to a rheumatology clinic with a 2-month history of low back pain. The pain seemed to be inflammatory in origin, with nocturnal occurrence and substantial early morning stiffness. The patient was previously well, with no history of psoriasis, inflammatory bowel disease or iritis.


METHODS
Physical examination, anteroposterior X-ray of the pelvis, isotope bone scan, CT and MRI of the sacroiliac joints, measurement of serum inflammatory markers, HLA-B27 testing, routine and mycobacterial culture of the sacroiliac joint fluid aspirate, tuberculosis skin testing and chest X-ray.


METHODS
An HLA-B27-negative patient with chronic unilateral sacroiliitis refractory to conventional management.


RESULTS
After unsuccessful treatment with various NSAIDs and physical therapy, local corticosteroid injections on two occasions in the affected sacroiliac joint provided transient relief. A subsequent 20 mg injection of infliximab into the affected joint resulted in clinical and radiological improvement that has been sustained for more than 2 years.
O'Shea
Finbar D
FD
Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada. boshea@uhnresearch.ca
Haroon
Nigil
N
Salonen
David C
DC
Inman
Robert D
RD
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D006801:Humans; D000069285:Infliximab; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab