Sacroiliitis

Overview

The term sacroiliitis is used to describe any inflammation in the sacroiliac joint – the joint located on either side of the sacrum (the lower spine) that connects to the iliac bone in the hip.

Sacroiliitis is often found as part of a feature of inflammatory conditions of the spinal column. As a group, these conditions and diseases are termed a “spondyloarthropathy” and include conditions such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, among others.

Sacroiliitis may also be a component of other types of arthritis, such as ulcerative colitis, Crohn’s disease, or osteoarthritis.

Sacroiliitis is also a term that is sometimes used interchangeably with the term sacroiliac joint dysfunction, as technically either term can be used to describe pain that stems from the sacroiliac joint (or SI joint).

Why is a sacroiliac joint injection helpful?

A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the joint is numb it means this joint is more likely than not your pain source. Furthermore, time-release cortisone will be injected into the joint to reduce any presumed inflammation, which on many occasions can provide long-term pain relief.

Although there are numerous ways to treat sacroiliac joint dysfunction, sacroiliac joint injections work powerfully to reduce your inflammation and they can provide months of relief.

Sacroiliitis vs. Sacroiliac Joint Dysfunction

Sacroiliitis vs. Sacroiliac Joint Dysfunction

Both sacroiliitis and sacroiliac joint dysfunction are a common cause of sacroiliac pain, low back pain and leg pain. However, there are differences between the two conditions:

Sacroiliitis

In medicine, the term “itis” refers to inflammation, and sacroiliitis describes inflammation of the sacroiliac joint. The inflammation may or may not be caused by sacroiliac joint dysfunction.

Sacroiliac Joint Dysfunction

This condition generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the SI joint, or sacroiliitis.

Sacroiliitis Symptoms

Sacroiliitis Symptoms

The most common symptoms of sacroiliitis include some combination of the following:

  • Fever
  • Pain, usually low back pain, leg pain (may be in the front of the thigh), hip pain, and/or buttock pain
  • Pain that is worse when sitting for a long time, and worse when rolling over in bed
  • Stiffness felt in the hips and low back, especially after getting out of bed in the morning or after sitting still for a prolonged period.

Sacroiliitis Causes

Sacroiliitis Causes

A wide range of factors may cause sacroiliitis or predispose one to developing sacroiliitis:

  • Any form of spondyloarthropathy, which includes ankylosing spondylitis, arthritis associated with psoriasis, and other rheumatologic diseases, such as lupus
  • Degenerative arthritis, or osteoarthritis of the spine, causing degeneration of the sacroiliac joints and in turn leading to inflammation and SI joint pain
  • A trauma that affects the lower back, hip or buttocks, such as a car accident or fall
  • Pregnancy and childbirth, as a result of the pelvis widening and stretching the sacroiliac joints during childbirth
  • Infection of the sacroiliac joint
  • Osteomyelitis
  • Urinary tract infection
  • Endocarditis
  • IV drug use / drug addition.

If a patient has pain in the sacroiliac area and any of the above conditions, he or she may have sacroiliitis or sacroiliac joint dysfunction.

The specific sacroiliitis treatments will be determined primarily by: 1) the type and severity of the patient’s symptoms, and 2) the underlying cause of the sacroiliitis.

There is a wide range of nonsurgical options available. Most patients find that a combination of two or more of the following nonsurgical treatments can be effective in managing their symptoms:

Sacroiliitis Treatment

Sacroiliitis Treatment

Rest
A short period of rest may help calm the inflamed sacroiliac joints.

Heat and/or ice
Warmth or cold applied to the area will provide local pain relief. Application of a cold pack will help reduce the inflammation in the area. Application of warmth, such as a heating pad or hot tub, will help stimulate blood flow and bring healing nutrients to the area.

Sleep position
Changing ones sleep position can help alleviate pain while sleeping and at waking. Most patients find it best to sleep on the side, with a pillow placed between the knees to keep the hips in alignment.

Medications 
For many, over-the-counter pain medications, such as acetaminophen, and/or anti-inflammatory medications, such as ibuprofen, provide sufficient pain relief. Prescription medications may be recommended, such as tramadol (brand name Ultram), or a short course of narcotic pain medications, or muscle relaxants, such as cyclobenzaprine (brand name Flexeril) to help reduce painful muscle spasms.

Sacroiliac joint injections
For severe pain, a sacroiliac joint injection may be recommended 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, which is a type of live x-ray, to ensure correct placement of the needle in the joint. The injection typically includes both a numbing agent, such as lidocaine, and a steroid, which is a strong anti-inflammatory medication.

Injections can typically be done up to three to four times in one year, and should be accompanied by physical therapy and/or chiropractic or osteopathic manual manipulation to restore proper range of motion and rehabilitation.

Sacroiliitis exercises
A prescribed physical therapy program of stretching, strengthening and low impact aerobic conditioning is usually a part of most sacroiliitis or sacroiliac joint dysfunction treatment regimens. The therapy may be done by a physical therapist, chiropractor or other appropriately trained health specialist.

During & After the Procedure

What will happen to me during the procedure?
If needed, an IV will be started so that adequate relaxation medication can be given. After lying on an x-ray table, the skin over your lower back/buttock will be well cleansed. Next, the physician will numb a small area of skin with numbing medicine (anesthetic) which stings for a few seconds. The physician then will use x-ray guidance to direct a very small needle into the joint. He will then inject several drops of contrast dye to confirm that the medication only goes into the joint. A small mixture of numbing medication (anesthetic) and anti-inflammatory cortisone will then be slowly injected.

What should I do and expect after the procedure?
20-30 minutes after the procedure, you will move your back to try to provoke your usual pain. You will report your remaining pain, (if any) and also record the relief you experience during the next week, on a “pain diary” we will provide. You may or may not obtain improvement in the first few hours after the injection, depending on if the sacroiliac joint is your main pain source. *Mail or fax the completed pain diary back as directed so that your treating physician can be informed of your results and plan future tests and/or treatment if needed.

On occasion, you may feel numb, slightly weak or have an odd feeling in your leg for a few hours after the injection. You may notice a slight increase in your pain lasting for several days as the numbing medication wears off before the cortisone is effective. Ice will typically be more helpful than heat in the first 2-3 days after the injection. You may begin to notice an improvement in your pain 2-5 days after the injection. If you do not notice improvement within 10 days after the injection, it is unlikely to occur. You may take your regular medications after the procedure, but try to limit them for the first 4-6 hours after the procedure, so that the diagnostic information obtained from the procedure is accurate. You may be referred for physical or manual therapy after the injection while the numbing medicine is effective and/or over the next several weeks while the cortisone is working.

On the day of the injection, you should not drive and should avoid any strenuous activities. On the day after the procedure, you may return to your regular activities. When your pain is improved, start your regular exercise/activities in moderation. Even if you are significantly improved, gradually increase your activities over 1-2 weeks to avoid recurrence of your pain.

Amish R. Patel, DO, MPH. “All About Sacroiliitis.” Spine-Health.com. (2011): n. page. Web.

http://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/all-about-sacroiliitis.

Paul Dreyfuss, MD. “Sacroiliac Joint Injection Information.” Spineuniverse.com. (2013): n. page. Web.

http://www.spineuniverse.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-injection-information.