Sacroiliitis
Sacroiliitis is a condition caused by inflammation within the sacroiliac joint, where the base of the spine, and the pelvis, connect. The term "sacroiliitis" combines the words sacrum, ilium, and the Latin term "itis", which denotes inflammation.
Inflammation in the SI joint can develop through several different processes. It is a feature of spondyloarthropathies, such as axial spondyloarthritis, psoriatic arthritis, reactive arthritis or arthritis related to inflammatory bowel diseases, including ulcerative colitis or Crohn's disease. It is also the most common presentation of arthritis from brucellosis. Problems with the SI joint are in some cases caused by injury in childbirth, other injury, a congenital condition, or a viral or bacterial infection.
Symptoms and signs
People suffering from sacroiliitis can often experience symptoms in a number of different ways, however it is commonly related to the amount of pressure that is put onto the SI joint. Symptoms commonly include prolonged, inflammatory pain in the lower back region, hips or buttocks. The pain is typically axial, meaning that the location of the condition is also where the pain is occurring. However, in more severe cases, the pain can become more radicular and manifest itself in seemingly unrelated areas of the body including the legs, groin and feet.Symptoms are typically aggravated by:
- Transitioning from sitting to standing
- Walking or standing for extended periods of time
- Running
- Climbing stairs
- Taking long strides
- Rolling over in bed
- Bearing more weight on one leg
Cause
- Degenerative arthritis, or osteoarthritis of the spine, can cause degeneration within the joints and lead to inflammation and joint pain.
- Any form of spondyloarthropathies, which includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis or arthritis related to inflammatory bowel diseases, including ulcerative colitis or Crohn's disease.
- Pregnancy can cause inflammation as a result of the widening and stretching of the SI joints to prepare for childbirth. Additionally, the added weight carried during childbearing can put an extra amount of stress on the SI joints, leading to abnormal wear.
- Traumatic injury such as a fall or car crash that affects the lower back, hips, buttocks or legs.
- Though rare, infection within the SI joints or another part of the body, such as a urinary tract infection, can cause inflammation.
Diagnosis
X-rays, MRIs and other medical imaging tests can be used to show signs of inflammation and damage within the SI joints. Typically, a spine specialist will order a medical imaging test if they suspect ankylosing spondylitis or another form of arthritis to be the primary cause of inflammation and pain.
Treatment
Treatment can vary depending on the severity of the condition, its cause, and the amount of pain the patient is currently experiencing. However, it typically falls into one of two categories: non-surgical and surgical.Non-surgical
In most cases sacroiliitis can be treated without surgery. Often patients will find relief through a combination of rest, heat / ice therapy, physical therapy and anti-inflammatory medication, like ibuprofen. Together these simple treatments help reduce inflammation in the affected SI joints. If the cause is an inflammatory condition such as spondyloarthritis, the treatment may involve NSAIDs or other drugs that are aimed at halting the progression of disease.For more severe forms of sacroiliitis, SI joint injections might be recommended to help combat symptoms. If chosen, a physician will inject a numbing agent, usually lidocaine, and a steroid containing powerful anti-inflammatory medication into the joint using fluoroscopic guidance. These steroid injections can be delivered up to three or four times a year and should be accompanied with physical therapy to help rehabilitate the affected joint.