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Active sacroiliitis and sacroiliac joint dysfunction represent a common cause of low back pain in the population and are cause of patients' quality of life reduction and disability worldwide. The use of musculoskeletal ultrasound allows to easily identify the sacroiliac joints and to study every pathological condition affecting its most dorsal part; moreover, musculoskeletal ultrasound allows to guide highly effective injective procedures aimed at improving patients' symptoms and enhance their well-being. This paper aims to briefly explain for the musculoskeletal sonographer the anatomy and biomechanics of the sacroiliac joints, the correct ultrasound scanning method for their visualization and the most appropriate ultrasound guided injection technique to help dealing with the diagnostic and management of sacroiliac joint pain in the everyday scenario. [ABSTRACT FROM AUTHOR]

Introduction: Active sacroiliitis represents the hallmark of axial spondyloarthritis (axSpA) and manifests as inflammatory low back pain associated with morning stiffness (MS). Sometimes, the combination of non-steroidal anti-inflammatory drugs (NSAIDs) and biological disease modifying drugs (bDMARDs) proves unsatisfactory in achieving a remission. Materials and methods: We enrolled patients affected with active sacroiliitis confirmed via magnetic resonance imaging (MRI) and treated with a corticosteroid sacroiliac joint injection (SIJI) via ultrasound guidance. After SIJI, we evaluated visual–analogue scale (VAS) and MS pain changes. As controls, we selected axSpA patients starting bDMARDs. Results: We enrolled 26 patients (mean age 55 ± 14 years; 25 females and 1 male; > 95% treated with NSAIDs; 46% on bDMARDs; 75.82 ± 123 months) and examined a total of 47 treated joints. We detected a 48% reduction in VAS pain after 24 h. Moreover, we observed a significant reduction (p < 0.0001) of VAS pain between the baseline and every subsequent follow-up visit. Further, a significant difference in VAS pain compared to the baseline in the controls was observed starting from week 12. There was a significant reduction in MS after 1 week due to SIJIs, while in the controls the first significant change from the baseline in MS was detected after 12 weeks. The efficacy of infiltrative therapy lasted up to 6 months: persistent VAS as well as MS pain reduction was observed. Conclusions: US-guided SIJI represents an effective and safe technique for patients who have active sacroiliitis yet are ineligible for biologic treatment or who experience unsatisfactory disease control despite receiving therapy. [ABSTRACT FROM AUTHOR]