Impact of steroid and lidocaine injection in the sacroiliac joint in axial spondyloarthritis patients: a randomized controlled trial

Background: The value of steroid and lidocaine injection of the sacroiliac joint in axial spondyloarthritis patients on magnetic resonance imaging scores and clinical disease outcome measures is not yet well assessed. Patient and methods: Participants were randomly assigned into two groups; Group I received unilateral ultrasound-guided sacroiliac joint injection with .5% lidocaine hydrochloride mixed with triamcinolone. At the same time, group II received subcutaneous saline injection. All participants fulfilled the ASAS criteria for axial SpA and all had bone marrow edema of at least one sacroiliac joint at baseline. Outcomes measures were: Visual Analogue Scale (VAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), and Spondyloarthritis Research Consortium of Canada (SPARCC) scores. Participants were assessed at baseline (before and after sacroiliac joint injection) and after three months. This clinical trial was registered on clinicaltrials.gov under the number NCT04895228. Results: In this study, a total of 61 participants were registered. There was a significant difference between both groups regarding pain, spine mobility, SPARCC, and ASDAS scores in favor of group I. Spine mobility showed the earliest improvement, followed by pain whilst SPARCC, and ASDAS scores showed improvement after three months. Higher disease activity, younger age, and shorter disease duration were all associated with better outcomes. Bilateral hip involvement was a predictor of poor response. Conclusion: Sacroiliac joint injection of lidocaine and triamcinolone in axial SpA patients is a cost-effective and practical technique for controlling pain, improving function, disease activity scores, and bone marrow edema with acceptable complications and relatively sustained effect.