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).

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.

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.