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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.

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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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