Evaluation of platelet-rich plasma vs steroid in the treatment of sacroiliitis by ultrasound-guided injection in patients with seronegative axial spondyloarthropathies

Abstract

ObjectiveThe aim was to evaluate the efficacy of ultrasound-guided (USG) sacroiliac injection of platelet-rich plasma (PRP) for sacroiliitis in seronegative axial spondyloarthropathies (SPAs) vs triamcinolone acetonide injection.BackgroundSacroiliitis is considered a hallmark for the diagnosis of seronegative SPA. Sacroiliac joint steroid injection is a commonly used technique. A novel promising injective treatment is PRP.Patients and methodsThis interventional study included 70 patients with seronegative axial SPA, from 2017 to 2019. The patients were divided into two groups: group I received USG injection of triamcinolone acetonide, and group II received USG injection of PRP. Patients were evaluated for pain intensity by visual analog scale (VAS) and Modified Oswestry Disability Questionnaire (MODQ) 4 and 8 weeks after injection and with MRI 8 weeks after injection.ResultsSteroid and PRP were effective in the treatment of sacroiliitis by USG injection. The improvement was significant and lasted longer in group II (68.6% became with mild pain regarding VAS and 74.3% of minimal disability regarding MODQ) as compared with group I after 8 weeks of injection. Patients who received steroids improved dramatically at 4 weeks (60% of patients experience mild pain regarding VAS and 45.7% became with minimal disability regarding MODQ), with decreased efficacy after 8 weeks. With follow-up with MRI, active sacroiliitis can be fully improved by PRP injection (57.1% with normal MRI result after 8 weeks).ConclusionsSteroid and PRP were effective in the treatment of sacroiliitis in seronegative SPA by USG injection, but PRP had a persistent and long-lasting effect.