Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity

• Published in: Modern rheumatology Vol. 25; no. 3; pp. 421 - 426
• Main Authors: Soliman, Eiman, El-tantawi, Gihan, Matrawy, Khaled, Aldawoudy, Akram, Naguib, Abir
• Format: Journal Article
• Language: English
• Published: United States Informa Healthcare 01.05.2015; Taylor & Francis
• Subjects: Adult; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - therapeutic use; Arthritis; Clinical trials; Humans; Infliximab - administration & dosage; Infliximab - therapeutic use; Injections; Injections, Intra-Articular; Joints; Magnetic Resonance Imaging; Male; NMR; Non-radiographic axial spondyloarthritis; Nonsteroidal anti-inflammatory drugs; Nuclear magnetic resonance; Rheumatology; Sacroiliac Joint - drug effects; Sacroiliac Joint - pathology; Sacroiliac joints; Sacroiliitis - drug therapy; Sacroiliitis - pathology; Severity of Illness Index; Spondylarthritis - drug therapy; Spondylarthritis - pathology; Treatment Outcome; Tumor necrosis factor alpha blockers; Young Adult; Non-radiographic axial spondyloarthritis; Tumor necrosis factor alpha blockers; Sacroiliac joints
• ISSN: 1439-7595; 1439-7609
• DOI: 10.3109/14397595.2014.972495

Abstract Objectives. 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. Conclusion. SIJ injection of IFX could be a therapeutic option in early nr-axial SpA who failed to respond to NSAIDs.