Therapeutic Evaluation of Intra-articular Platelet-Rich Plasma, Steroid, and Viscosupplement Injections for Sacroiliitis: A Retrospective Comparative Study

TL;DR

This study compares the effectiveness of steroid, platelet-rich plasma (PRP), and viscosupplement injections for treating sacroiliitis, finding that PRP provides the best long-term pain relief.

Contribution

The study introduces a comparative evaluation of PRP, steroids, and viscosupplements for sacroiliitis, highlighting PRP's superior mid-term outcomes.

Findings

Corticosteroid injections provided the most rapid early pain reduction but less long-term benefit.

PRP injections showed the greatest improvement in pain and disability at six months.

Viscosupplementation offered sustained clinical benefits and safety.

Abstract

Introduction

Sacroiliitis is a well-recognized cause of axial low back pain and significantly contributes to chronic cases seen in orthopedic and pain clinics. While intra-articular corticosteroid injections provide established short-term symptom relief, their long-term effectiveness remains variable. Platelet-rich plasma (PRP) has emerged as a biological alternative with regenerative potential, and viscosupplementation using hyaluronic acid offers viscoelastic and anti-inflammatory effects that may enhance joint function. This study aimed to compare the therapeutic efficacy of intra-articular corticosteroid, PRP, and viscosupplement injections in treating sacroiliitis.

Materials and methods

This retrospective comparative study included 60 adults with clinically and magnetic resonance imaging (MRI)-confirmed sacroiliitis who were treated between January 2022 and December 2024. Patients received one of the following treatments: fluoroscopy-guided intra-articular injection of 40 mg methylprednisolone acetate combined with lidocaine (steroid group; n=20), 5 mL of autologous PRP prepared using a standardized double-spin centrifugation protocol (PRP group; n=20), or intra-articular hyaluronic acid viscosupplementation (viscosupplement group; n=20). Pain and functional status were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, one week, one month, three months, and six months. Statistical analysis was conducted using repeated measures and one-way analysis of variance (ANOVA).

Results

Baseline VAS scores were comparable among the steroid (7.9±0.8), PRP (7.8±0.9), and viscosupplement (7.8±0.7) groups (p>0.05). The steroid group demonstrated greater early pain reduction at one week (4.6±0.9) compared to the PRP (6.2±0.8) and viscosupplement (5.8±0.9) groups. At six months, the PRP group showed the greatest improvement, with a mean VAS of 3.8±1.0, followed by the viscosupplement group (4.3±1.1), while the steroid group had higher scores (5.1±1.2) (p<0.05). Similarly, the mean ODI at six months was lowest in the PRP group (31.9±6.8%), followed by the viscosupplement (35.6±7.2%) and steroid groups (40.3±7.5%) (p<0.05). All groups showed significant improvement from baseline (p<0.001). No major complications were observed.

Conclusion

Intra-articular injections of corticosteroids, PRP, and viscosupplements effectively reduce pain and disability in sacroiliitis. Corticosteroids provide rapid early symptom relief, while PRP demonstrates superior mid-term improvement. Viscosupplementation offers sustained clinical benefits and represents a safe and effective therapeutic alternative.