
==== Front
Interv Pain Med
Interv Pain Med
Interventional Pain Medicine
2772-5944
Elsevier

S2772-5944(23)00125-5
10.1016/j.inpm.2023.100293
100293
Letters to the Editor
Potential factors influencing success in intra-articular sacroiliac joint injections
Andrassy Bennett bennett22pl@gmail.com
∗
Mukhdomi Junaid
Pain Labs, New Albany, OH, 43054, USA
∗ Corresponding author. Clinical Researcher at Pain Labs, New Albany, OH, 43054, USA. bennett22pl@gmail.com
20 11 2023
12 2023
20 11 2023
2 4 10029324 10 2023
1 11 2023
© 2023 The Authors
2023
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords

Sacroiliac joint injection
Sacroiliac joint pain
Steroid choice
Triamcinolone
Methylprednisolone
Physical therapy
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pmcDear Editor,

We read the article by Kristoff et al. in the September issue of Interventional Pain Medicine with great interest. The authors conducted a retrospective observational study on the therapeutic efficacy of intra-articular sacroiliac joint (SIJ) injections for reducing pain and improving quality of life in 351 patients with SIJ dysfunction [1]. While the diagnostic value of SIJ injections is well-established, their efficacy as a therapeutic intervention has not been clearly demonstrated [2]. The study by Kristoff et al. expands the body of evidence supporting intra-articular SIJ injections as a source of significant pain relief in patients with SIJ dysfunction. One month after their first injection, 60 % of participants reported a minimal clinically important difference (MCID) in pain, as assessed by the NRS. After one year, 32.5 % of participants reported persistent MCIDs. The study also utilized questionnaires assessing quality of life, disability, and mental health, including PHQ-9, PDQ, EQ-5D, and PROMIS-GH. Many participants saw improvements in quality of life, physical function, and depression, though these effects were less profound than the observed pain relief. We congratulate the authors for conducting a well designed study, and for their robust assessment of multiple patient-reported outcome domains.

While the study represents a remarkable step towards legitimizing intra-articular SIJ injections as a therapeutic, we noticed areas that could be clarified by the authors in order to better understand the implications of their findings. The authors noted that SIJ injections of triamcinolone tended to be less effective than methylprednisolone, though a small number of patients receiving methylprednisolone had an 80mg dose, while patients receiving triamcinolone exclusively had 40mg doses. Recent research tends to support the use of triamcinolone over methylprednisolone in lumbar epidural and shoulder steroid injections [3,4], potentially due to methylprednisolone's lesser selectivity for glucocorticoid receptors and ability to activate proinflammatory mineralocorticoid receptors [3]. However, a study comparing the two steroids in SIJ injections found no significant differences, with marginally better pain relief and opioid sparing in the methylprednisolone group [5]. We request that the authors release quantifications of the comparative efficacies of these common corticosteroids; this will aid in understanding whether this study suggests superiority of methylprednisolone over triamcinolone in SIJ injection. We are especially interested in what percentage of the triamcinolone group reported MCID in pain at each assessment time point.

Additionally, Kristoff et al. reported that the physician performing the injections in this study emphasized the importance of physical therapy (PT) to each study participant. The authors also noted that data on prior PT was difficult to reliably collect, and thus excluded from subgroup analyses. However, we are curious as to whether the authors have data on the amount of participants that utilized PT after the injections. As PT strengthening the pelvic floor and piriformis muscles is known to stabilize the SIJ [2], this data could clarify the role of PT in restoring patients’ physical functioning following SIJ injection.

We welcome all additional comments regarding this important study. Many thanks to the authors for their valuable contributions.

Funding disclosure statement

The authors received no funding for this manuscript.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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References

1 Kristoff T.J. Sinopoli J.T. Farley T. Rabah N. Thompson N.R. Goyal K. The therapeutic effectiveness of fluoroscopically guided intra-articular sacroiliac joint injections in patients with sacroiliac joint dysfunction, an observational study Interventional Pain Med 2 3 2023 100269 10.1016/j.inpm.2023.100269
2 Falowski S. Sayed D. Pope J. A review and algorithm in the diagnosis and treatment of sacroiliac joint pain J Pain Res 13 2020 3337 3348 10.2147/jpr.s279390 33335420
3 Higgins Z.R. Qualls K.A. Garg S. Zhang J.-M. Strong J.A. Retrospective study of the efficacy of methylprednisolone vs. triamcinolone in lumbar epidural steroid injections for the treatment of back pain due to degenerative disc disease J Pain 23 5 2022 28 10.1016/j.jpain.2022.03.111
4 Eason R.R. Joyce M.R. Throckmorton T.W. Comparison of triamcinolone and methylprednisolone efficacy and steroid flare reaction rates in shoulder corticosteroid injection: a prospective interrupted time series study J Shoulder Elbow Surg 2023 10.1016/j.jse.2023.05.023
5 Krishnan R. Kurup V. Vadivelu N. Dai F. Zhou B. Rajput K. Does choice of steroid matter for treatment of chronic low back pain with sacroiliac joint injections: a retrospective study Curr Pain Headache Rep 25 5 2021 10.1007/s11916-021-00942-7
