Skip to main content

Ultrasound-guided intra-sacroiliac joint injection — methylprednisolone versus triamcinolone: a randomized comparative study

Abstract

Background

The sacroiliac joint (SIJ) has been considered as a pain generator in about 10% to 25% of patients with leg or low back pain. The current study was conducted to compare the effectiveness of ultrasound-guided intra-articular SIJ injection of methylprednisolone versus triamcinolone acetonide according to postinjection pain relief, the random blood glucose (RBG) level in diabetic patients, quality of life (QoL), patient’s satisfaction, and the analgesic requirement.

Results

NRS was better at rest and at motion in MTP groups 3 (2–3) and 4 (3–5) compared to TMC groups 4 (3–5) and 5 (3–6) at 2 weeks after injection with statistically significant difference P equal 0.025 and 0.036, respectively, while there was no statistically significant difference between the studied groups at 1, 2, and 3 months after injection. The RBG level was higher in the MTP group in the 1st, 2nd, and 3rd days after injection 206 (168–308), 245 (200–385), and 215 (179–343) compared to the TMC group 170 (136–271), 168 (119–233), and 166 (110–253) with statistically significant difference P equal 0.066, 0.045, and 0.049, respectively. However, there was no statistically significant difference in the RBG level at baseline, 4th, 5th, 6th, and 7th days after injection between the two studied groups. Moreover, there was a statistically significant elevation in the RBG level within the MTP group in the first 3 days compared to the baseline (P ˂ 0.001). There was no statistically significant difference according to QoL, patient’s satisfaction, and the analgesic requirement between both groups.

Conclusions

SIJ injection with methylprednisolone or triamcinolone acetonide showed an improvement in pain score, while the MTP group was better in NRS at 2 weeks. Also, the RBG level in diabetic patients was higher in the MTP group in the 1st, 2nd, and 3rd days after injection. There was upgrading in QoL, similarity in patient’s satisfaction, and reducing the use of analgesia with no statistically significant difference between the studied groups.

Background

The sacroiliac joint (SIJ) has been considered as a pain generator in about 10% to 25% of patients with leg or low back pain (Thawrani et al. 2019). Inflammatory arthritis, patients with leg length discrepancy, pregnancy, advanced age, trauma, and previous spine surgeries increase the risk of SIJ pain (Huynh and Hsu 2019).

The anatomical structure and inter-individual variations in SIJ render its injections challenging to do without any guidance (fluoroscopy, ultrasound, or computerized tomography) (Wu et al. 2021). When ultrasound-guided injection compares to other guidance, it provides accurate, safe, inexpensive imaging, easy, non-invasive, and lacking exposure to radiation (Rosenberg et al. 2000).

Intra-articular steroids injection is a good alternative for the patients with SIJ osteoarthritis as it delays any surgical intervention with better pain relief and thereby the patient’s quality of life (QoL) will improve (Najm et al. 2021).

Among the common steroid preparations available, methylprednisolone (MTP) and triamcinolone acetonide (TMC) are the two most common particulate steroids used in clinical practice. However, there are lack of studies comparing the two steroids in SIJ injections.

The current study was conducted to compare the effectiveness of ultrasound-guided intra-articular SIJ injection of MTP versus TMC according to postinjection pain relief, the RBG level in diabetic patients, quality of life (QoL), patient’s satisfaction, and the analgesic requirement.

Methods

This prospective randomized double-blinded comparative study was conducted in pain clinic, Mansoura university hospital, Egypt. The study was accepted by the Institutional Research Board, Faculty of Medicine, (MS 20.07.1195), and the ClinicalTrials.gov registration (NCT05134181) and was carried out in compliance with the Helsinki Declaration. All participants signed an informed consent after explanation of all details about the study.

Age between 50 and 70 years of both sexes; sacroiliac pain with at least 3 positive tests of the 5 provocative tests (Gaenslen test, FABER/Patrick’s test, thigh thrust, anterior superior iliac spinous distraction, and iliac compression); pain was not alleviated by the conservative therapy (rest, topical menthol, ice/heat, lidocaine patch, NSAIDs, pelvic belt, and physical therapy) for 4 weeks; and positive diagnostic test (intra-articular SIJ injection with 2-ml lidocaine 2% 1 day before the procedure) were included in this study.

The exclusion criteria were patient’s refusal to participate in the study, history of immunosuppression diseases, bleeding disorders, septic joint, local skin infection, renal patients (serum creatinine > 1.8 mg/dl ), osteomyelitis, local malignancy, decompensated liver diseases, previous history of chronic opioid use, psychiatric disorders affecting cooperation, intra-articular sacroiliac injection within previous 3 months, hypersensitivity or allergy to any of the study medications, negative diagnostic test, morbid obesity (BMI > 40 kg/m2), and diabetes mellitus (type 2 with history of poor glycemic control).

CT was performed to all included patients to confirm diagnosis of SIJ dysfunction and excluded other sources of low back pain. All the patients were informed about numerical rating scale (NRS) for pain from zero to 10 to describe their pain (0 = no pain, while 10 = worst pain). The resident in the pain clinic asked the patients about their QoL by using EQ‐5D‐5L questionnaire which contains five items: mobility, self-care, usual activities (e.g., work, study, housework, or family activities), pain or discomfort, and anxiety or depression, and each item ranges from no, slight, moderate, severe, or unable (Devlin et al. 2018). Also, the RBG level in diabetic patients was measured, and the analgesic requirement was recorded.

Sample size calculation

Sample size was calculated according to the mean NRS score after 20-min walk between the studied groups (methylprednisolone and triamcinolone acetonide) recorded at 8 weeks after injection (5.61 & 6.30), respectively (Jain and Jain 2015), using G*Power version 3.0.10 to calculate SD difference of (0.09) with effect size = 0.64, α error = 0.05, and power = 80.0%. The calculated sample size was 40 patients in each group and with adding 10% to compensate for drop out, and then, the total sample size was 45 patients at least in each group

Randomization

The randomization was performed using sealed envelopes indicating the group of the assignment at the time of the first visit to the pain clinic by a chief nurse, who read the number inside the envelope and determined group assignments, but did not join in patients’ follow-up.

Patients were randomly allocated into 2 equal groups (Fig. 1):

  • Group MTP: (n = 45) received ultrasound-guided intra-articular sacroiliac injection with 2 mL of 2% lidocaine hydrochloride and 40 mg of methylprednisolone.

  • Group TMC: (n = 45) received ultrasound-guided intra-articular sacroiliac injection with 2 mL of 2% lidocaine hydrochloride and 40 mg of triamcinolone acetonide.

Fig. 1
figure 1

Consort flow chart

Technique of ultrasound-guided intra-articular SIJ injection (Harmon and Michael 2008)

At patient arrival to recovery room, an IV line was secured, normal saline 0.9% solution was infused, and oxygen mask (3 l/min) was supplemented. Heart rate, blood pressure, and saturation were monitored. At complete aseptic conditions, ultrasound at frequency of 4–5 MHz was used. Patient was in prone position. The ultrasound probe was oriented at the level of the sacral hiatus in a transverse orientation; the sacral cornua were recognized. The probe was moved laterally until identify the lateral edge of the sacrum. In a transverse orientation, the bony edge of the sacrum is followed in a cephalad direction. The second bony contour was the ileum. The cleft between the two bony contours was the SIJ. The depth was at about 4.5 cm. A 22-G spinal needle was directed into the SIJ under real-time imaging. Also, under direct vision, 2 mL of 2% lidocaine and 40-mg methylprednisolone or 40-mg triamcinolone acetonide was injected (Fig. 2). The needle was withdrawn, and a sterile dressing was applied. Then, the patient laid down in supine position. The blood pressure, O2 saturation, heart rate, and any adverse effect was monitored for at least 30 min.

Fig. 2
figure 2

Ultrasound view of the SIJ shows the ileum and the sacrum. The yellow line is the track of the needle entrance

If the NRS was ≥ 4, NSAID in the form of 20-mg piroxicam was given once daily after meal to control the pain.

Evaluation

Primary outcome

NRS at rest and during motion (during stair climbing or standing up from a seated position or walking) before injection and at an interval of 2 weeks and 1, 2, and 3 months after injection was assessed.

Secondary outcomes

The RBG level in diabetic patients before and on the first 7 days after injection; QoL by using EQ‐5D‐5L before injection and after 1 month of injection including mobility, self-care, usual activity, pain/discomfort, and anxiety/depression; the patient’s satisfaction (not satisfied, satisfied, and highly satisfied), and the analgesic requirement (20-mg piroxicam) were evaluated.

Statistical analysis

Data were analyzed using version 22 SPSS (Statistical Package for the Social Sciences). Qualitative data was presented as number and percent. Kolmogorov-Smirnov test was used for normality of quantitative data where the normal distributed data described as mean and standard deviation while the non-normally distributed data described as median and range. The appropriate statistical test was applied according to data type; categorical variable and chi-square were used. Continuous variables, Mann-Whitney U-test, and Student’s t-test were used. The probability (P) was considered statistically significant if it was less than 0.05.

Results

According to the mean age of patients, in the MTP group was 59.11 ± 7.33 and in the TMC group was 61.47 ± 6.91 years with no statistically significant difference between the two groups. The females represented the highest percentage of the cases (71.1% and 73.3%), while males represented 28.9% and 26.7% in the MTP and TMC groups respectively with no statistically significant difference between the two groups. The mean BMI in the MTP group was 31.59 ± 4.20 kg/m2 and in the TMC group was 32.08 ± 3.63 with no statistically significant difference between the two groups. There was no statistically significant difference between the duration of the disease, ASA score, and number of diabetic patients between the two groups. The left side was affected in 68.9 and 62.2%, and the right side was affected in 31.1% and 37.8% in the MTP and TMC groups respectively with no statistically significant difference between the two groups (Table 1).

Table 1 Demographic data, duration of the disease, number of diabetic patients, and the affected side of SIJ in the two studied groups

Table 2 shows that NRS was better at rest and at motion after injection in MTP group at 2 weeks than TMC group with statistically significance P-values 0.025 and 0.036, respectively, while there was no statistically significant difference in the NRS at rest and at motion between the two groups at the baseline and in 1, 2, and 3 months after injection. Within groups, there was a statistically significant decrease in the NRS at rest and at motion in 2 weeks and 1, 2, and 3 months after injection compared to the baseline.

Table 2 Numerical rating score at rest and at motion in the two studied groups along the study period

Table 3 shows increase in the RBG level in MTP group in the 1st, 2nd, and 3rd days after injection 206 (168-308), 245 (200–385), and 215 (179–343) compared to TMC group 170 (136–271), 168 (119–233), and 166 (110–253) with statistically significant difference P equal 0.066, 0.045, and 0.049, respectively. However, there was no statistically significant difference in the RBG level at baseline, 4th, 5th, 6th, and 7th days after injection between the two studied groups. Moreover, there was statistically significant elevation in the RBG level within MTP group in the first 3 days compared to the baseline (P < 0.001), and there was no statistically significant difference at the rest of the week. Also, there was no statistically significant difference in TMC group in all days of the week compared to before injection.

Table 3 The random blood glucose of the diabetic patients in the two studied groups before and after 1 week from injection

Table 4 shows that there was no statistically significant difference in the QoL in all domains of EQ‐5D‐5L questionnaire between the two groups before injection.

Table 4 QoL in the two studied groups before injection

Table 5 shows that there was no statistically significant difference in the QoL in all domains of EQ‐5D‐5L questionnaire between the two groups after injection. However, there was a statistically significant improvement in all domains of the QoL according to before and after injection in both groups with P < 0.001.

Table 5 QoL in the two studied groups after injection and comparison between before (Table 4) and after injection

Table 6 shows that there was no statistically significant difference in the patient satisfaction between the two groups. Four patients in MTP group and five patients in TMC group were not satisfied. A total of 77.8% in MTP group and 75.6% in TMC group were satisfied, while 6 patients in each group were highly satisfied. There was no statistically significant difference in the analgesic requirement (20-mg piroxicam) between the two groups (24.4% in MTP group and 20% in TMC group), while in each group the analgesic requirement was decreased with statistically significant difference P1 equal 0.0254 in MTP group and 0.0098 in TMC group.

Table 6 Patient satisfaction and the analgesic requirement in the two studied groups

Discussion

Several studies showed good efficacy and safety of steroids intra-articular injections to treat osteoarthritis. But still the type of steroids is up to doctor’s expertise (Bellamy et al. 2006; Gaujoux-Viala et al. 2009).

The current study was conducted to compare the effectiveness of ultrasound-guided intra-articular SIJ injection of MTP versus TMC according to NRS, the random blood glucose in diabetic patients, QoL, patient’s satisfaction, and the analgesic requirement.

In this trial, the intra-articular SIJ injection was performed with ultrasonic guidance because blind technique has high failure rate. Also, there were various advantages of ultrasound over other guidance that it is easily available imaging method with less radiation, economical, real time, and reproducible (Pekkafalı et al. 2003; Singla et al. 2017).

Kumar et al. studied the efficacy of triamcinolone acetonide versus methylprednisolone intra-articular knee injection and found that there was a significant drop in pain and swelling scores during the follow-up periods (P < 0.001) in both groups. However, within groups, there were no significant differences up to 6 months. This is consistent with our results as there was a decline in NRS in each group during the follow-up periods compared to the baseline, and there was no significant difference between the studied groups at 1, 2, and 3 months after injection (Kumar et al. 2017).

Another trial randomized 120 patients with knee pain which compared three types of steroids: triamcinolone acetonide, methylprednisolone, and betamethasone disodium phosphate intra-articular injection. The three steroids promoted functional and symptomatic improvement for up to 3 months. However, methylprednisolone was more effective in relieving pain compared with the others until week 6 (P < 0.05). In our study, MTP group showed significant improvement difference at 2 weeks compared with TMC group at rest P = 0.025 and at motion P = 0.036 (Yavuz et al. 2012).

This can be explained by the fact that particulate steroids, such as methylprednisolone acetate and triamcinolone acetonide, are composed of microcrystals ranging from 3 to 15 times the size of erythrocytes. Triamcinolone acetonide, being the least soluble steroid agent with the greatest potency, has densely packed particles that differ in size ranging from 15 to 60 μm. In comparison, methylprednisolone acetate has uniformly sized, densely packed particles ranging from 0.5 to 26 μm in size, with < 5% of particles > 50 μm in diameter that do not form many aggregations, and this makes it more soluble (Shah et al. 2019).

The findings in the current study are in contrast to Pyne et al. who reported that triamcinolone was statistically more efficient in pain relief 3 weeks after intra-articular knee injection than methylprednisolone (Pyne et al. 2004).

Choudhry et al. performed a systematic review of studies observing the outcome of intra-articular steroid injections on blood glucose levels in patients with diabetes mellitus, and they stated that intra-articular steroid injections elevate blood glucose level in patients with diabetes mellitus, and it should be regularly monitored for up to a week after injection, while postinjection hyperglycemia happened within 24 to 72 h (Choudhry et al. 2016).

Furthermore, Safran et al. studied the effect of MTP intra-articular shoulder injection on blood glucose level in patients with type 2 diabetes and found that hyperglycemic changes are short lived and are limited up to 2–3 days after injection. This is in agreement with MTP group in our study that showed an elevation in the RBG level at the 1st, 2nd, and 3rd days after SIJ injection with statistically significant difference with TMC group (P < 0.05) (Safran et al. 2022).

Feldman et al. evaluated the blood glucose level after intravitreal TMC injection in diabetic patients and concluded that there was no differential effect on blood glucose observed after an intravitreal TMC injection compared with vitrectomy alone (Feldman-Billard et al. 2008).

Transient and limited increase in blood glucose has been reported in nondiabetic patients after intra-articular injections, and its baseline level returned by 24 h (Uboldi et al. 2009; Moon et al. 2014).

Bisicchia et al. measured QoL using the 36-Item Short-Form Survey (SF-36) score after intra-articular knee injection, and they noted improvements in QoL in MTP group extended up to 12 months (Bisicchia et al. 2016). Also Nabi et al. compared the effectiveness of intra-articular platelet-rich plasma (PRP) and TMC injection under ultrasound guidance on knee osteoarthritis and assessed QoL using the KOOS QoL scale. They found improvements in QoL in both groups, but greater improvements in QoL were seen in PRP group at 3 months (P = 0.02) and 6 months (P < 0.0001). In the current study, there was no statistically significant difference in QoL between MTP and TMC groups, but there was a statistically significant difference in each group compared to the baseline (P < 0.001) (Nabi et al. 2018).

The analgesic requirement was significantly reduced after injection in both groups in our study, and this was in accordance with Jagdish et al., who concluded that the combination injection of intra-articular local anesthetic and corticosteroid is effective and safe, achieves immediate pain relief up to 6 months, and decreases the usage of NSAID (Jagdish et al. 2018).

Fouad et al. reported that 91.2% of patients were satisfied or mostly satisfied after SIJ injection with MTP, and this is within the same line with our result as 77.8% of patients were satisfied and 13.3% were highly satisfied in MTP group which showed no statistically significant difference with TMC group, where 75.6% of patients were satisfied and 13.3% were highly satisfied (Fouad et al. 2021).

Conclusions

SIJ injection with methylprednisolone or triamcinolone acetonide showed an improvement in pain score, while MTP group was better in NRS at 2 weeks. Also, RBG level in diabetic patients was higher in MTP group in the 1st, 2nd, and 3rd days after injection. There was an upgrading in QoL, similarity in patient’s satisfaction, and a reduction in the use of analgesia with no statistically significant difference between the studied groups.

Availability of data and materials

All data generated or analyzed during this study are included in this published article; we sent in the supplementary information files.

Abbreviations

SIJ:

Sacroiliac joint

MTP:

Methylprednisolone

TMC:

Triamcinolone acetonide

QoL:

Quality of life

NRS:

Numerical rating scale

RBG:

Random blood glucose

References

  • Bellamy N, Campbell J, Welch V, Gee TL, Bourne R, Wells GA (2006) Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 19(2):CD005328

  • Bisicchia S, Bernardi G, Tudisco C (2016) HYADD 4 versus methylprednisolone acetate in symptomatic knee osteoarthritis: a single-centre single blind prospective randomised controlled clinical study with 1-year follow-up. Clin Exp Rheumatol 34(5):857–63

    PubMed  Google Scholar 

  • Choudhry MN, Malik RA, Charalambous CP (2016) Blood glucose levels following intra-articular steroid injections in patients with diabetes: a systematic review. JBJS Rev 4(3):e5

    Article  PubMed  Google Scholar 

  • Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B (2018) Valuing health-related quality of life: an EQ-5 D-5 L value set for E ngland. Health Econ 27(1):7–22

    Article  PubMed  Google Scholar 

  • Feldman-Billard S, Chibani A, Héron E (2008) Intravitreal triamcinolone and blood glucose. Ophthalmology 115(5):917

    Article  PubMed  Google Scholar 

  • Fouad AZ, Ayad AE, Tawfik KAW, Mohamed EA, Mansour MA (2021) The success rate of ultrasound-guided sacroiliac joint steroid injections in sacroiliitis: are we getting better? Pain Pract 21(4):404–10

    Article  PubMed  Google Scholar 

  • Gaujoux-Viala C, Dougados M, Gossec L (2009) Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis 68(12):1843–9

    Article  CAS  PubMed  Google Scholar 

  • Harmon D, Michael O et al (2008) Ultrasound-guided sacroiliac joint injection technique. Pain Phys 11(4):543

    Article  Google Scholar 

  • Huynh P, Hsu D (2019) Comparison of lateral branched pulsed radiofrequency denervation and intraarticular depot methylprednisolone injection for sacroiliac joint pain: inquiry for additional investigation. Pain Phys 22(1):E53–E54

    Article  Google Scholar 

  • Jagdish RK, Bhatnagar MK, Malhotra A (2018) Shailly. Eff Saf a Comb Intra-articular corticosteroid Local Anesth Indian Patients with Knee Osteoarthr a pilot study. Austin J Orthopade Rheumatol 5(1):1061

    Google Scholar 

  • Jain P, Jain SK (2015) Comparison of efficacy of methylprednisolone and triamcinolone in osteoarthritis of the knee: a prospective, randomized, double-blind study. Int J Sci Study 3(5):58–62

    Google Scholar 

  • Kumar A, Dhir V, Sharma S, Sharma A, Singh S (2017) Efficacy of methylprednisolone acetate versus triamcinolone acetonide intra-articular knee injection in patients with chronic inflammatory arthritis: a 24-week randomized controlled trial. Clin Ther 39(1):150–8

    Article  CAS  PubMed  Google Scholar 

  • Moon HJ, Choi KH, Lee SI, Lee OJ, Shin JW, Kim TW (2014) Changes in blood glucose and cortisol levels after epidural or shoulder intra-articular glucocorticoid injections in diabetic or nondiabetic patients. Am J Phys Med Rehabil 93(5):372–8

    Article  PubMed  Google Scholar 

  • Nabi BN, Sedighinejad A, Mardani-Kivi M, Haghighi M, Roushan ZA, Biazar G (2018) Comparing the effectiveness of intra-articular platelet-rich plasma and corticosteroid injection under ultrasound guidance on pain control of knee osteoarthritis. Iran Red Crescent Med J 20(3):e62157

  • Najm A, Alunno A, Gwinnutt JM, Weill C, Berenbaum F (2021) Efficacy of intra-articular corticosteroid injections in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Jt Bone Spine 88(4):105198

    Article  CAS  Google Scholar 

  • Pekkafalı MZ, Kıralp MZ, Başekim CÇ, Şilit E, Mutlu H, Öztürk E et al (2003) Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 22(6):553–9

    Article  Google Scholar 

  • Pyne D, Ioannou Y, Mootoo R, Bhanji A (2004) Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone hexacetonide and methylprednisolone acetate. Clin Rheumatol 23(2):116–20

    Article  PubMed  Google Scholar 

  • Rosenberg JM, Quint DJ, de Rosayro AM (2000) Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain 16(1):18–21

    Article  CAS  PubMed  Google Scholar 

  • Safran O, Fraind-Maya G, Kandel L, Leibowitz G, Beyth S (2022) The effect of steroid injection into the shoulder on glycemia in patients with type 2 diabetes. JSES Int 6(5):843–8

    Article  PubMed  PubMed Central  Google Scholar 

  • Shah A, Mak D, Davies AM, James SL, Botchu R (2019) Musculoskeletal corticosteroid administration: current concepts. Can Assoc Radiol J 70(1):29–36

    Article  PubMed  Google Scholar 

  • Singla V, Batra YK, Bharti N, Goni VG, Marwaha N (2017) Steroid vs. platelet-rich plasma in ultrasound-guided sacroiliac joint injection for chronic low back pain. Pain Pract 17(6):782–91

    Article  PubMed  Google Scholar 

  • Thawrani DP, Agabegi SS, Asghar F (2019) Diagnosing sacroiliac joint pain. JAAOS-Journal Am Acad Orthop Surg 27(3):85–93

    Article  Google Scholar 

  • Uboldi F, Carlo-Stella N, Belloli L, Massarotti M, Marasini B (2009) Glucose blood levels after intra-articular steroid injection in diabetic and non-diabetic patients. Clin Rheumatol 28(4):491–2

    Article  PubMed  Google Scholar 

  • Wu L, Tafti D, Varacallo M (2022) Sacroiliac joint injection. InStatPearls. StatPearls Publishing

  • Yavuz U, Sökücü S, Albayrak A (2012) Efficacy comparisons of the intraarticular steroidal agents in the patients with knee osteoarthritis. Rheumatol Int 32(11):3391–6

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None applicable.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

AA and NA conceived of the presented idea. AAZ verified the analytical methods. EK collected the cases. NA and EK did the clinical part in the research. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Nevert Adel Abdel Ghaffar.

Ethics declarations

Ethics approval and consent to participate

Our study was accepted by the Institutional research board, of Faculty of Medicine, Mansoura University, Egypt (MS 20.07.1195), registered in the ClinicalTrials.gov (NCT05134181) and carried out in compliance with the Helsinki Declaration. All participants signed an informed consent after explanation of all details about the study.

Consent for publication

Every patient participating in this study signed an informed consent after full explanation of all details in this study.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghaly, E.K.E., Attia, A.A., Zagloul, A.A.E. et al. Ultrasound-guided intra-sacroiliac joint injection — methylprednisolone versus triamcinolone: a randomized comparative study. Ain-Shams J Anesthesiol 15, 31 (2023). https://doi.org/10.1186/s42077-023-00330-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s42077-023-00330-w

Keywords