Sacroiliitis: Symptoms, Diagnosis, Treatment

Overview

Sacroiliitis is the inflammation of one or both of your sacroiliac joints which situate where your lower spine and pelvis connect. If you have developed sacroiliitis, you may have symptoms such as pain in your buttocks or lower back which may extend down one or both legs. The sensation may worsen if you stand or climb for a long time.

Considering lower back pain or pain in the buttocks or thighs may be the result of multiple conditions, sacroiliitis can be difficult to diagnose. According to the statistics, approximately 15% to 25% of people who report low back pain are diagnosed with sacroiliitis. Since it can be mistaken for other causes of low back pain, it’s crucial to be precisely diagnosed by professionals. Typically, sacroiliitis has been linked to a group of disease that cause inflammatory arthritis of the spine.

Causes

A wide range of factors may be held accountable for causing sacroiliitis. Possible factors are further explained as follows:

• Endocarditis

• Osteomyelitis

• Urinary tract infection

• IV drug use/drug addition

• Existing back or spine issues

• Infection of the sacroiliac joint

• An altered gait or loosened joints during pregnancy

• A trauma/damage that affects the lower back and the hip from falling or after a car accident

• Any form of spondyloarthropathy (ankylosing spondylitis, arthritis associated with psoriasis, and other rheumatologic diseases

• Degenerative arthritis, or osteoarthritis of the spine, causing degeneration of the sacroiliac joints and in turn leading to inflammation and SI joint pain

Sacroiliitis Grading

Sacroiliitis grading can be achieved using plain radiographs according to the New York criteria.

Grade 0: normal

Grade I: some blurring of the joint margins – suspicious

Grade II: minimal sclerosis with some erosion

Grade III

• definite sclerosis on both sides of joint 5

• severe erosions with widening of joint space with or without ankylosis

Grade IV: complete ankylosis

Symptom

Affected people may feel sharp, stabbing, or dull and achy pain. The pain caused by sacroiliitis most commonly occurs in the lower back and buttocks. It can also affect the legs, groin and even the feet. Sacroiliitis pain can be worsened by: Prolonged standing, running, stair climbing, taking large strides, or bearing more weight on one leg than the other. It may also be aggregated if one tends to get out of a chair or rotate his/her hips.

Complications

Sacroiliitis associated with ankylosing spondylitis can progress over time. With the passage of time, this type of arthritis causes the vertebrae (bones) in your spine to fuse and stiffen. If left untreated, sacroiliitis may end up causing a loss of mobility for some people, making it hard to move your body. Untreated pain also can disrupt your sleep and lead to psychological conditions like depression and insomnia.

Diagnosis

A specific diagnosis is concluded based on the results of the following procedures:

Medical History

To make a precise diagnosis, your doctor will first ask you about your medical history, inquiring if you have previous inflammatory disorders or conditions.

Physical Exam and Movement Tests

To pinpoint the cause of your pain, the doctor may order a physical exam during which the spine is examined for proper alignment and rotation. Besides, you may also undergo some movement tests during which you’ll be asked to move in specific directions. In some of these tests, the doctor applies pressure to your sacroiliac joint, spine, hip, or leg. The greater the number of tests’ results (bring on pain), the higher the likelihood that you have sacroiliitis.

Blood Tests

Blood tests are conducted to look for signs of inflammation.

Imaging Tests

X-rays and CT scans may be ordered if the doctor suspects an injury as the source of pain. During the tests, the doctor may look for changes in the sacroiliac joint. If ankylosing spondylitis is suspected, your doctor might recommend an MRI — a test that uses radio waves and a strong magnetic field to produce very detailed cross-sectional images of both bone and soft tissues.

Steroid Injection

An injection of steroids into the sacroiliac joint is both applied as a diagnostic test and a method of treatment. X-ray is used to guide the spinal needle to the appropriate location for the injection.

Anesthetic Injection

Since low back pain can be the result of multiple factors, your doctor might suggest using numbing injections (anesthetics) to help identify the exact cause. In detail, if such an injection into your sacroiliac joint alleviate your pain, it’s likely that it has something to do with your sacroiliac joint. However, the numbing medicine can leak into nearby structures, lowering the reliability of this test.

Treatment

Treatment options vary depending on the severity of your symptoms, and the underlying cause of your sacroiliitis. Basically, there are non-surgical treatments for sacroiliitis and surgical treatments for sacroiliitis. In most cases, affected people benefit from physical therapy (sacroiliitis exercises) which helps stabilize and strengthen the muscles surrounding your sacroiliac joints.

Non-Surgical Treatments

Many nonsurgical options proven to be effective can be applied at home. For example, a combination of two or more of the following options may be beneficial to improving your condition:

• Taking a short period of rest

• Provide Local pain relief with cold pack or heating pad/hot tub

• Changing your sleep position

• Taking OTC medications (e.g. ibuprofen), prescription medications (Ultram), or a short course of narcotic pain medications or muscle relaxants to help alleviate symptoms such as painful muscle spasms.

Surgical Treatments

In some severe cases, sacroiliac joint injections may be applied both to confirm the sacroiliac joint as the source of the pain and to introduce the anti-inflammatory medication directly into the joint. The injection is done with fluoroscopic guidance (a type of live x-ray) to ensure correct placement of the needle in the joint. Other surgical options may include: Radiofrequency denervation, electrical stimulation or joint fusion.

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Keywords: sacroiliitis