Sacroiliitis is inflammation of the sacroiliac (SI) joint, located at the bottom of the spine where it connects to the pelvis. This condition can affect one or both sides of the body, leading to lower back pain that may radiate down to the legs.
The inflammation can be caused by various factors, including falls, spinal issues, pregnancy, osteoarthritis, psoriatic arthritis, or gout. However, sacroiliitis is most commonly associated with ankylosing spondylitis, a type of rheumatological disease.
Proper diagnosis and treatment are essential for managing sacroiliitis. Treatment options vary depending on the underlying cause and may include medications, physical therapy, or, in some cases, surgery.
Sacroiliitis symptoms
The main symptoms of sacroiliitis include:
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Pain or stiffness in the lower back;
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Pain in the hips and buttocks;
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Pain that may radiate to the legs.
Typically, the pain worsens when sitting or standing for extended periods and increases when performing movements that involve rotating the hips.
In some cases, sacroiliitis may also cause fever if accompanied by an infection.
Bilateral Sacroiliitis
Bilateral sacroiliitis occurs when inflammation affects both SI joints at the same time. Unlike unilateral sacroiliitis, which affects only one side, bilateral sacroiliitis can cause widespread pain in the lower back, hips, and buttocks.
Chronic Sacroiliitis
Sacroiliitis is considered chronic if the inflammation and pain persist for three months or more.
Confirming a diagnosis
An orthopedic specialist or rheumatologist can diagnose sacroiliitis based on a review of symptoms, medical history, and any previous trauma to the affected area, along with a physical exam.
If you experience symptoms of sacroiliitis, it's important to consult with an orthopedic surgeon in your area.
During the physical exam, the doctor may ask you to perform certain movements to assess your range of motion and may apply pressure to the joints to identify areas of pain.
Imaging tests, such as X-rays, CT scans, or MRIs, can help visualize the SI joint and any inflammation. Blood tests may also be used to rule out infections or other conditions, like arthritis, Crohn's disease, or reactive arthritis, which may share similar symptoms.
Possible causes
Sacroiliitis can be related to several conditions, including:
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Osteoarthritis;
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Gout;
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Ankylosing spondylitis;
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Infection in the SI joint;
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Trauma to the SI joint (e.g., from a fall or accident);
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Lumbar osteoarthritis;
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Tumor in the joint;
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Hyperparathyroidism.
In addition, sacroiliitis may develop due to excessive stress on the joints, such as in athletes who jump or run, or in individuals with overweight or obesity.
Pregnancy can also contribute to sacroiliitis, as the hormone relaxin causes the ligaments and joints in the pelvis to loosen. Additionally, the weight of the growing abdomen can alter posture and walking patterns, which may lead to inflammation in the SI joints.
Can sacroiliitis be serious?
Although sacroiliitis is rarely severe, it can cause significant pain and limit mobility. With proper treatment, symptoms can be managed, and complications can be avoided.
However, if left untreated, sacroiliitis may lead to permanent loss of mobility. When associated with ankylosing spondylitis, it may result in the fusion and stiffening of the vertebrae.
Sacroiliitis treatment
Treatment for sacroiliitis should be guided by an orthopedic surgeon or rheumatologist. The goal is to alleviate symptoms and improve mobility. Possible treatment options include:
1. Physical therapy
Physical therapy is a common treatment for sacroiliitis. A physical therapist may recommend stretching exercises and movements to strengthen the muscles around the SI joints.
These exercises help reduce pressure on the joints and improve flexibility, providing long-term relief.
2. Medications
Medications prescribed to manage pain and inflammation may include:
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Analgesics, such as acetaminophen;
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Anti-inflammatory drugs, such as ibuprofen;
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Muscle relaxants, such as cyclobenzaprine;
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Opioids, such as tramadol;
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Antibiotics, if an infection in the SI joint is present.
Injections of anti-inflammatory and anesthetic medications directly into the joint can also provide immediate pain relief and improve mobility.
For sacroiliitis related to ankylosing spondylitis, biologic therapies such as etanercept, adalimumab, or infliximab may be prescribed to help reduce joint inflammation and pain.
3. Radiofrequency ablation
Radiofrequency ablation involves applying electrical currents to block pain-transmitting nerves in the SI joint. This procedure can reduce pain and provide relief by interrupting nerve activity.
4. Surgery
If the pain becomes chronic and other treatments have not been effective, surgery may be considered. This surgical procedure aims to fuse the bones of the SI joint, reducing pain and improving mobility.
Can sacroiliitis be cured?
Sacroiliitis does not have a permanent cure, but its symptoms can be managed effectively through treatment, physical therapy, and medication. With the right treatment plan, most people can continue with their daily activities comfortably.
In cases related to pregnancy, the pain usually resolves after delivery.