Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity.
OBJECTIVE
To evaluate the effectiveness of infliximab (IFX) injection into sacroiliac joints (SIJs) of non-radiographic axial spondyloarthritis (nr-axial SpA) and its impact on clinical and MRI parameters of disease activity.


METHODS
Thirty-seven patients fulfilling the Association of Spondyloarthritis International Society (ASAS) criteria for axial SpA were initially studied, with disease duration not exceeding 1 year and failed to respond to non-steroidal anti-inflammatory drugs (NSAIDs). Only SpA having active sacroiliitis on MRI without spondylitis (number = 7) were selected to receive bilateral SIJ injection of 20 mg IFX. Follow-up MRI was done at 24 weeks post-injection. Patients were clinically evaluated before, and 12 and 24 weeks after SIJ injection. Evaluation included back pain and stiffness scores, and Bath Ankylosing Spondylitis (BAS) Disease indices and C-reactive protein (CRP) levels. ASAS response criteria were also assessed.


RESULTS
Twelve and twenty-four weeks after injection, there was significant decrease in back pain, stiffness, and BAS Disease Activity and Global indices. BAS Functional index, CRP, and mean bone marrow edema score of SIJs were decreased without reaching statistical significance. All patients achieved ASAS20 and five (71.4%) achieved ASAS40.


CONCLUSIONS
SIJ injection of IFX could be a therapeutic option in early nr-axial SpA who failed to respond to NSAIDs.
Internal Medicine and Rheumatology, Alexandria Faculty of Medicine, Alexandria University , Alexandria , Egypt.
Eiman
E
Soliman
Gihan
G
El-Tantawi
Khaled
K
Matrawy
Akram
A
Aldawoudy
Abir
A
Naguib
D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D012446:Sacroiliac Joint / Q000187:drug effects* / Q000473:pathology; D058566:Sacroiliitis / Q000188:drug therapy* / Q000473:pathology; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
D018501:Antirheumatic Agents; D000069285:Infliximab
Non-radiographic axial spondyloarthritis; Sacroiliac joints; Tumor necrosis factor alpha blockers