Sacroiliitis

Description, Causes and Risk Factors:

Sacroiliitis is an inflammation of one or both of your sacroiliac joints, which connect your lower spine and pelvis. Sacroiliitis can cause pain in your buttocks or lower back, and may even extend down one or both legs. The pain associated with sacroiliitis is often aggravated by prolonged standing or by stair climbing.Sacroiliitis

Sacroiliitis has been linked to a group of diseases called spondyloarthropathies, which cause inflammatory arthritis of the spine. Sacroiliitis can be difficult to diagnose, because it may be mistaken for other causes of low back pain. Treatment of sacroiliitis may involve a combination of rest, physical therapy and medications.

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.
Risk Factors: The following factors may increase your likelihood of getting the condition: A history of bone, joint or skin infections. Some people are more prone to infections, and an infection is one possible cause of sacroiliitis.
  • Injury or trauma to your spine, pelvis or buttocks. Torn ligaments or trauma may create inflammation or infection of the sacroiliac joints.
  • Urinary tract infection. This infection may spread from your urinary tract, which includes your kidneys, bladder and urethra, to your sacroiliac joints.
  • Pregnancy. The pelvic bone's expansion to prepare for childbirth may inflame the area around your sacroiliac joints.
  • Endocarditis. This infection of your heart's inner lining may spread to your sacroiliac joints.
  • Illicit drug use. People who inject drugs may have a higher risk of developing 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 pain can be aggravated by: Prolonged standing.
  • Bearing weight more on one leg than the other.
  • Stair climbing.
  • Running.
  • Large strides.
  • Extreme postures.
Diagnosis:

Most of times, the clinical diagnosis ofsacroiliitis is difficult, depending substantially on the confirmation of radiologicalfindings, where conventional x-ray, andcurrently, computerized tomography (CT)and magnetic resonance imaging (MRI)assume essential role.

Imaging tests may include: X-rays. Plain X-rays can reveal signs of damage to the sacroiliac joint.
  • Computerized tomography (CT scan). CT scans combine X-ray images taken from many different angles to create cross-sectional images of internal structures.
  • Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, MRI machines produce very detailed cross-sectional images of both bone and soft tissues.

If your doctor suspects that you have an infection in your sacroiliac joint, he or she may want to run tests on a sample of fluid from within that joint. The sample is obtained with a needle. Because the sacroiliac joint is located so deep within the body, the doctor may use ultrasound or another imaging technique to ensure that the needle is placed correctly.

Treatment:

The type of treatment your doctor will recommend depends on the signs and symptoms you're having, as well as the underlying cause of your sacroiliitis.

Medications

Muscle relaxants. Medications such as cyclobenzaprine (Flexeril) may help reduce the muscle spasms often associated with sacroiliitis.

  • Pain relievers. If over-the-counter pain medications don't provide enough relief, your doctor may prescribe a non-narcotic pain reliever, such as tramadol (Ultram). Occasionally, a short course of narcotics may be prescribed. These drugs are habit-forming and shouldn't be used for long periods of time.
  • Corticosteroids. Drugs such as betamethasone (Celestone) or triamcinolone (Kenalog) can be injected into the joint to reduce inflammation and pain. But you can receive only a few joint injections a year because the steroids can weaken your joint's bones and tendons.
  • Disease-modifying antirheumatic drugs (DMARDs). If your sacroiliitis is caused by ankylosing spondylitis, you may be helped by drugs such as sulfasalazine (Azulfidine) and methotrexate.
  • TNF inhibitors. Tumor necrosis factor (TNF) inhibitors — such as etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) — often help relieve the type of sacroiliitis that's associated with ankylosing spondylitis.
Surgical and other procedures: If other methods haven't relieved your pain, you doctor might suggest: Radiofrequency denervation. Radiofrequency energy can damage or destroy the nerve tissue causing your pain.
  • Electrical stimulation. Implanting an electrical stimulator into the sacrum may help reduce pain caused by sacroiliitis.
  • Joint fusion. Although surgery is rarely used to treat sacroiliitis, fusing the two bones together with metal hardware can sometimes relieve sacroiliitis pain.
Therapy: Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to maintain joint flexibility, and strengthening exercises to give your muscles additional stability. NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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