SpringerLink
Log in

Tomography-guided palisade sacroiliac joint radiofrequency neurotomy versus celecoxib for ankylosing spondylitis: a open-label, randomized, and controlled trial

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Sacroiliac joint (SIJ) pain is a common symptom in ankylosing spondylitis (AS). Palisade sacroiliac joint radiofrequency neurotomy (PSRN) is a novel treatment for the SIJ pain. In the current clinical trial, we treated AS patients with significant SIJ pain using PSRN under computed tomography guidance and compared the results with the celecoxib treatment. The current study included 155 AS patients. Patients were randomly assigned to receive PSRN or celecoxib treatment (400 mg/day for 24 weeks). The primary endpoint was global pain intensity in visual analog scale, at week 12. Secondary endpoints included pain intensity at week 24, disease activity, functional and mobility capacities, and adverse events at week 24. In comparison with the baseline collected immediately prior to the interventions, global pain intensity was significantly lower at both 12 and 24 weeks after the treatment in both arms. Pain reduction was more robust in the PSRN arm (by more than 1.9 and 2.2 cm at 12 and 24 weeks in comparison with the celecoxib arm, P < 0.0001 for both). The PSRN was also more effective in improving physical function and spinal mobility (P < 0.05 vs. celecoxib for both). Gastrointestional irritation was more frequent in the celecoxib arm than in the PSRN arm (P < 0.05). No severe complications were noted in either arm. PSRN is both efficacious and safe in managing SIJ pain in patients with AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sieper J, van der Heijde D, Dougados M, Brown LS, Lavie F, Pangan AL (2012) Early response to adalimumab predicts long-term remission through 5 years of treatment in patients with ankylosing spondylitis. Ann Rheum Dis 71:700–706

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Saraux A, Guillemin F, Guggenbuhl P, Roux CH, Fardellone P, Le Bihan E et al (2005) Prevalence of spondyloarthropathies in France: 2001. Ann Rheum Dis 64:1431–1435

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Passalent LA (2011) Physiotherapy for ankylosing spondylitis: evidence and application. Curr Opin Rheumatol 23:142–147

    Article  PubMed  Google Scholar 

  4. Sieper J (2012) Developments in therapies for spondyloarthritis. Nat Rev Rheumatol 8:280–287

    Article  CAS  PubMed  Google Scholar 

  5. Langford RM (2006) Pain management today: what have we learned? Clin Rheumatol 25:2–8

    Article  Google Scholar 

  6. Kiltz U, Heldmann F, Baraliakos X, Braun J (2012) Treatment of ankylosing spondylitis in patients refractory to TNF-inhibition: are there alternatives? Curr Opin Rheumatol 24:252–260

    Article  CAS  PubMed  Google Scholar 

  7. Reveille JD, **menes A, Ward MM (2012) Economic considerations of the treatment of ankylosing spondylitis. Am J Med Sci 343:371–374

    Article  PubMed Central  PubMed  Google Scholar 

  8. Rudwaleit M, Jurik AG, Hermann KG, Landewé R, van der Heijde D, Baraliakos X et al (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68:1520–1527

    Article  CAS  PubMed  Google Scholar 

  9. Poddubnyy D, Sieper J (2012) Radiographic progression in ankylosing spondylitis/axial spondyloarthritis: how fast and how clinically meaningful? Curr Opin Rheumatol 24:363–369

    Article  PubMed  Google Scholar 

  10. Ramiro S, Radner H, van der Heijde D, van Tubergen A, Buchbinder R, Aletaha D et al (2011) Combination therapy for pain management in inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis). Cochrane Database Syst Rev 5:CD008886

    Google Scholar 

  11. Maugars Y, Mathis C, Vilon P, Prost A (1992) Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 35:564–568

    Article  CAS  PubMed  Google Scholar 

  12. MaldjianC Mesgarzadeh M, Tehranzadeh J (1998) Diagnostic and therapeutic features of facet and sacroiliac joint injection: anatomy, pathophysiology, and technique. Radiol Clin N Am 36:497–508

    Article  Google Scholar 

  13. Cohen SP, Strassels SA, Kurihara C, Crooks MT, Erdek MA, Forsythe A et al (2009) Outcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation. Reg Anesth Pain Med 34:206–214

    Article  PubMed  Google Scholar 

  14. Patel N, Gross A, Brown L, Gekht G (2012) A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med 13:383–398

    Article  PubMed  Google Scholar 

  15. Rupert MP, Lee M, Manchikanti L, Datta S, Cohen SP (2009) Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician 12:399–418

    PubMed  Google Scholar 

  16. Hansen HC, McKenzie-Brown AM, Cohen SP, Swicegood JR, Colson JD, Manchikanti L (2007) Sacroiliac joint interventions: a systematic review. Pain Physician 10:165–184

    PubMed  Google Scholar 

  17. McKenzie-Brown AM, Shah RV, Sehgal N, Everett CR (2005) A systematic review of sacroiliac joint interventions. Pain Physician 8:115–125

    PubMed  Google Scholar 

  18. Hansen H, Manchikanti L, Simopoulos TT, Christo PJ, Gupta S, Smith HS et al (2012) A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician 15:247–278

    Google Scholar 

  19. Cohen SP (2005) Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis and treatment. Anesth Analg 101:1440–1453

    Article  PubMed  Google Scholar 

  20. Cosman ER Jr, Gonzalez CD (2011) Bipolar radiofrequency lesion geometry: implications for palisade treatment of sacroiliac joint pain. Pain Pract 11:3–22

    Article  PubMed  Google Scholar 

  21. Greher M, Kirchmair L, Enna B, Kovacs P, Gustorff B, Kapral S et al (2004) Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology 101:1195–1200

    Article  PubMed  Google Scholar 

  22. Moher D, Schulz KF, Altman DG, CONSORT Group (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol 1:2

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  Google Scholar 

  24. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R et al (2009) The Assessment of Spondylo Arthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68(2):1–44

    Google Scholar 

  25. Morović-Vergles J, Gamulin S (2010) Anti-TNFα therapy and control of chronic pain in ankylosing spondylitis. J Pain Symptom Manag 40:9–11

    Article  Google Scholar 

  26. Keefe FJ, Somers TJ (2010) Psychological approaches to understanding and treating arthritis pain. Nat Rev Rheumatol 6:210–216

    Article  PubMed  Google Scholar 

  27. Dougados M, Béhier JM, Jolchine I, Calin A, van der Heijde D, Olivieri I et al (2001) Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of ankylosing spondylitis: a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflammatory drug. Arthritis Rheum 44:180–185

    Article  CAS  PubMed  Google Scholar 

  28. Zochling J, van der Heijde D, Dougados M, Braun J (2006) Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis 65:423–432

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Uhrin Z, Kuzis S, Ward MM (2000) Exercise and changes in health status in patients with ankylosing spondylitis. Arch Intern Med 160:2969–2975

    Article  CAS  PubMed  Google Scholar 

  30. Aytekin E, Caglar NS, Ozgonenel L, Tutun S, Demiryontar DY, Demir SE (2012) Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions. Clin Rheumatol 31:91–97

    Article  PubMed  Google Scholar 

  31. Committee for Medicinal Products for Human Use (CHMP) (2009) Guidelines on clinical investigation of medicinal products for the treatment of ankylosing spondylitis. European Medicines Agency. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003424.pdf. Accessed 26 Sep 2013

Download references

Acknowledgments

This study was supported by the National Key Basic Research Program (973 Program) of China (Grant No. 2007CB512504). The authors thank Profs. Shuang Ye (Department of Rheumatology, Renji Hospital, Shanghai, China) and Jian** Tang (Department of Rheumatology, Tongji Hospital, Shanghai, China) for critically reviewing the manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Pain Management, Renji Hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China

    Yongjun Zheng, Le Ye & ** Shi

  2. Department of Anesthesiology, Shanghai First Rehabilitation Hospital, 349 Hangzhou Road, Yangpu District, Shanghai, 200090, China

    Mingli Li

Authors
  1. Yongjun Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Minghong Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong** Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mingli Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Le Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. **angrui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to ** Shi, and Le Ye contributed to this work equally.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zheng, Y., Gu, M., Shi, D. et al. Tomography-guided palisade sacroiliac joint radiofrequency neurotomy versus celecoxib for ankylosing spondylitis: a open-label, randomized, and controlled trial. Rheumatol Int 34, 1195–1202 (2014). https://doi.org/10.1007/s00296-014-2959-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-014-2959-5

Keywords

Search

Navigation