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Clinical and radiographic response to a local infliximab injection in a patient with chronic sacroiliitis

Nature Reviews Rheumatology volume 5, pages 171–173 (2009)Cite this article

Abstract

Background A 49-year-old man presented to a rheumatology clinic with a 2-month history of low back pain. The pain seemed to be inflammatory in origin, with nocturnal occurrence and substantial early morning stiffness. The patient was previously well, with no history of psoriasis, inflammatory bowel disease or iritis.

Investigations Physical examination, anteroposterior X-ray of the pelvis, isotope bone scan, CT and MRI of the sacroiliac joints, measurement of serum inflammatory markers, HLA-B27 testing, routine and mycobacterial culture of the sacroiliac joint fluid aspirate, tuberculosis skin testing and chest X-ray.

Diagnosis An HLA-B27-negative patient with chronic unilateral sacroiliitis refractory to conventional management.

Management After unsuccessful treatment with various NSAIDs and physical therapy, local corticosteroid injections on two occasions in the affected sacroiliac joint provided transient relief. A subsequent 20 mg injection of infliximab into the affected joint resulted in clinical and radiological improvement that has been sustained for more than 2 years.

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Figure 1: MRI of the SIJ of a patient with chronic unilateral sacroiliitis taken at four separate time points.

References

  1. van der Linden S et al. (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27: 361–368

    Article  CAS  PubMed  Google Scholar 

  2. Dougados M et al. (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34: 1218–1227

    Article  CAS  PubMed  Google Scholar 

  3. Zochling J et al. (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65: 442–452

    Article  CAS  PubMed  Google Scholar 

  4. Braun J et al. (2008) Persistent clinical efficacy and safety of anti-tumour necrosis factor alpha therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response. Ann Rheum Dis 67: 340–345

    Article  CAS  PubMed  Google Scholar 

  5. Conti F et al. (2005) Successful treatment with intra-articular infliximab for resistant knee monoarthritis in a patient with spondylarthropathy: a role for scintigraphy with 99mTc-infliximab. Arthritis Rheum 52: 1224–1226

    Article  PubMed  Google Scholar 

  6. Schatteman L et al. (2006) Treatment of refractory inflammatory monoarthritis in ankylosing spondylitis by intraarticular injection of infliximab. J Rheumatol 33: 82–85

    CAS  PubMed  Google Scholar 

  7. Sakellariou GT et al. (2006) Intraarticular injection of infliximab. J Rheumatol 33: 1912–1913

    PubMed  Google Scholar 

  8. Fisher BA and Keat A (2006) Should we be using intraarticular tumor necrosis factor blockade in inflammatory monoarthritis? J Rheumatol 33: 1934–1935

    PubMed  Google Scholar 

  9. Kellner H et al. (2002) Successful therapy of sacroiliitis in AS patients by intraarticular injection of infliximab. Arthritis Rheum 46: S431

    Google Scholar 

  10. Bokarewa M and Tarkowski A (2003) Local infusion of infliximab for the treatment of acute joint inflammation. Ann Rheum Dis 62: 783–784

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ahern MJ et al. (2008) Effect of intra-articular infliximab on synovial membrane pathology in a patient with a seronegative spondyloarthropathy. Ann Rheum Dis 67: 1339–1342

    Article  CAS  PubMed  Google Scholar 

  12. Alstergren P et al. (2008) Successful treatment with multiple intra-articular injections of infliximab in a patient with psoriatic arthritis. Scand J Rheumatol 37: 155–157

    Article  CAS  PubMed  Google Scholar 

  13. Nikas SN et al. (2004) Treatment of resistant rheumatoid arthritis by intra-articular infliximab injections: a pilot study. Ann Rheum Dis 63: 102–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. and RD Inman is a Professor of Medicine at the Division of Rheumatology, FD O'Shea and N Haroon are Fellows, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada.,

    Finbar D O'Shea, Nigil Haroon & Robert D Inman

  2. DC Salonen is an Associate Professor at the Medical Imaging Department, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada.,

    David C Salonen

Authors
  1. Finbar D O'Shea
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  2. Nigil Haroon
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  3. David C Salonen
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  4. Robert D Inman
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Corresponding author

Correspondence to Finbar D O'Shea.

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Competing interests

D Salonen and R Inman declared that have both acted as consultants for Schering/Centocor, Amgen/Wyeth and Abbott. The other authors declared no competing interests.

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O'Shea, F., Haroon, N., Salonen, D. et al. Clinical and radiographic response to a local infliximab injection in a patient with chronic sacroiliitis. Nat Rev Rheumatol 5, 171–173 (2009). https://doi.org/10.1038/ncprheum1003

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