Injective Therapies for Managing Sacroiliac Joint Pain in Spondyloarthropathy: A Systematic Review and Meta-Analysis
Tosca Cerasoli, Giuseppe Filardo, Antongiulio Favero, Vito Gaetano Rinaldi, Laura Di Maio, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini
Abstract
Background: The most effective treatment approach for sacroiliac joint (SIJ) pain in spondyloarthropathy (SpA) patients remains unclear. This systematic review and meta-analysis aimed to assess the safety and effectiveness of different injective therapies for SIJ pain in SpA patients. Methods: A comprehensive literature search was conducted up to January 2024. The inclusion criteria encompassed studies in English, including comparative and non-comparative studies, and case series. A meta-analysis was performed on the available data. The “Checklist for Measuring Quality” by Downs and Black was used to evaluate the quality of included papers. Results: A total of 17 studies involving 494 patients were included: 12 prospective case series, 1 retrospective comparative study, 2 prospective comparative studies, and 2 randomized controlled trials. Steroid injections were analyzed in 15 studies, etanercept in 1, and infliximab in 1. A meta-analysis of 375 patients receiving steroid injections showed a significant reduction in visual analog scale (VAS) scores from 8.2 pre-treatment to 3.2 (p < 0.001) at short-term follow-up, with stability at mid-term follow-up (VAS 3.3, p < 0.001) and worsening at the last follow-up (VAS 5.1, p < 0.001). The failure rate was 13% (p = 0.019), and one study reported a 12.5% complication rate. Biologic therapies showed no complications or failures, with improvements in both VAS and BASDAI scores. Conclusions: Intra-articular steroid injections are effective and safe for SIJ pain in SpA patients, although their efficacy diminishes over time, and not all patients respond to treatment. Biologic therapies have shown promising results, but further research is needed to confirm their long-term efficacy.