How do you get Sacroiliitis?

Sacroiliitis can be caused by conditions such as osteoarthritis, spondyloarthropathies, pregnancy, injury or trauma, and bacterial infections.

What are signs and symptoms of Sacroiliitis?

Signs and symptoms of Sacroiliitis include: - Pain in the lower back, which can be felt in one or both buttocks, hips, thighs, or even further away. - Worsening of pain after sitting for a long time or during twisting movements. - Varying descriptions of pain, with some patients experiencing it as sharp and stabbing, while others feel it as a dull ache. - History of inflammatory conditions. - Other symptoms such as fever, chills, night sweats, or weight loss, which could indicate a more serious underlying condition. In addition to these signs and symptoms, a close inspection may reveal unevenness in the patient's pelvis, and measuring the lengths of the limbs can help rule out uneven leg lengths. The spine should also be inspected for any unusual curvatures or rotations. Tests for range of motion, nerve function, and strength usually do not show anything abnormal, although they may cause pain for some individuals. Special tests can help confirm a diagnosis of Sacroiliitis by recreating the patient's pain. These tests include the "Fortin finger sign" test, the FABER test, the sacral distraction test, the iliac compression test, the Gaenslen test, the thigh thrust test, and the sacral thrust test. The more of these tests that produce pain, the more likely it is that the sacroiliac joint is the source of the discomfort.

What kinds of test are needed for Sacroiliitis?

The types of tests that a doctor might order to properly diagnose Sacroiliitis include: - Blood tests: complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, human leukocyte antigen (HLA-B27), and rheumatoid factor - Radiographic images or x-rays: to show changes in the SI joint due to age or disease - CT scans: to show changes in the SI joint, abnormal bone growths, or abnormal movement - Magnetic Resonance Imaging (MRI): to show swelling in the bone below the cartilage of the SI joint, which is an early sign of sacroiliitis - Positron Emission Tomography (PET) scans: to check for cancer that could be spreading to the bones - Injection of local anesthetics and steroids into the SI joint: to diagnose and alleviate pain - Physical therapy: to stabilize and strengthen muscles or increase movement in the SI joint - Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants: for early stage symptoms - Image-guided intra-articular anesthetic/steroid injection: to reduce inflammation and provide pain relief - Radiofrequency ablation: to reduce nerve supply and pain - Surgery: Sacroiliac (SI) joint fusion as a last resort.

What else can Sacroiliitis be?

The other conditions that a doctor needs to rule out when diagnosing Sacroiliitis are: - Ankylosing spondylitis (a type of arthritis affecting the spine) - Hip tendonitis or fracture - Piriformis syndrome (a condition causing sciatica-like symptoms) - Sacroiliac joint infection (infection in the joint linking the lower spine and pelvis) - Trochanteric bursitis (inflammation of the bursa in the hip)

What type of doctor should I see for Sacroiliitis?

You should see a rheumatologist for Sacroiliitis.

How is Sacroiliitis treated?

Sacroiliitis can be treated through various methods. Physical therapy is beneficial for managing pain caused by hypermobility or stiffness, as it stabilizes and strengthens the muscles in the lower back and pelvic region or increases movement in the Sacroiliac (SI) joint. In the early stages, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants may be prescribed, but their effectiveness decreases as the condition becomes more chronic. An image-guided intra-articular anesthetic/steroid injection can be used to diagnose and reduce discomfort by injecting a local anesthetic and steroid into the painful joint. Radiofrequency ablation is an option to reduce pain by reducing the nerve supply to the painful area using radio waves. If these treatments are unsuccessful, surgery, specifically Sacroiliac (SI) joint fusion, may be considered as a last resort to limit movement and reduce pain.

Sacroiliitis

What is Sacroiliitis?

Sacroiliitis is an inflammation in the sacroiliac joint (SI), which is one of the largest joints in your body and plays a key role in linking the ilium bone (part of your hip) with the sacrum (base of your spine). It often results in back or buttock pain. Diagnosing sacroiliitis can be complicated because its symptoms resemble other common back pain conditions, making it easy to overlook as a potential source of pain.

Though experiencing pain from sacroiliitis is typically due to long-term degeneration, this sort of cause isn’t common. It’s also important to consider that sacroiliitis might be a secondary symptom resulting from other conditions, including rheumatic diseases, infections, reactions to drugs, or cancer-related factors.

Examples of such conditions that don’t involve degeneration but can still lead to sacroiliitis are ankylosing spondylitis (a form of arthritis that primarily affects the spine), psoriatic arthropathy (joint disease associated with psoriasis skin condition), Bechet disease (a rare autoimmune disease), hyperparathyroidism (excessive activity in the parathyroid gland), and various infectious sources.

What Causes Sacroiliitis?

Many conditions can cause inflammation of the SI (sacroiliac) joint, a joint located between the spine and the hip, leading to substantial pain. Osteoarthritis, a condition where the protective cartilage that cushions the ends of your bones wears down, can damage this joint and cause it to move irregularly, leading to discomfort. Other types of arthritis like spondyloarthropathies, a family of chronic diseases that affect a person’s joints, can also lead to significant inflammation.

Pregnancy is another factor that can cause inflammation of the SI joint. The hormone relaxin, which is produced during pregnancy and prepares the body for childbirth, can cause the joint to relax, stretch, or even widen. Additionally, the increased weight during pregnancy puts extra pressure on the joint, leading to more wear and tear.

Injury or trauma can directly or indirectly put stress on and damage the SI joint. Furthermore, a condition known as sacroiliitis, which is most frequently linked to bacterial infections, is a common cause of acute (sudden onset) inflammation of the SI joint. Pain might either originate from the joint itself or from the ligaments on the back of the sacrum, the large, triangular bone at the base of the spine.

Risk Factors and Frequency for Sacroiliitis

Sacroiliac pain, which is a type of lower back pain, affects different percentages of people according to various studies, with some stating it affects between 10% to 25% of those with lower back pain. When this type of pain is confirmed, it mostly affects the same side of the buttock (94% of cases) and the middle lower back area (74% of cases). However, the way it affects people can vary. In some cases, the pain can even spread, or ‘radiate,’ to other parts of the body.

The pain can radiate to the lower extremity (legs) in up to 50% of cases.
In 6% of cases, the pain can spread to the upper lumbar area (upper lower back).
The groin area is affected in 4% of cases.
In 2% of cases, the pain can occur in the lower abdomen.

Signs and Symptoms of Sacroiliitis

Sacroiliitis is usually identified by pain in the lower back. However, this pain can take many forms and might be felt in one or both buttocks, the hips, thighs, or even further away. The pain may worsen after sitting for a long time or during twisting movements. Descriptions of the pain vary widely, with some patients describing it as sharp and stabbing, while others experience it as a dull ache. It’s crucial to investigate more than just the pain. It is also important to ask about any history of inflammatory conditions and thoroughly review any other symptoms the patient might be experiencing, for example, fever, chills, night sweats, or weight loss. The presence of these symptoms could imply a more serious underlying condition.

While it’s not always clear, a close inspection can sometimes reveal unevenness in the patient’s pelvis. Measuring the lengths of the limbs can help to rule out uneven leg lengths. The spine should also be inspected for any unusual curvatures or rotations. Usually, tests for range of motion, nerve function, and strength don’t point to anything abnormal, although these tests can cause pain for some people.

Special tests can help to recreate the patient’s pain and confirm a diagnosis. These tests include:

The “Fortin finger sign” test – in which the doctor applies pressure to the patient’s sacroiliac joints, or SI joints, at the back of the pelvis and checks if this reproduces the pain.
The FABER test – which includes flexing, abducting, and externally rotating the hip to see if this causes pain.
The sacral distraction test – in which the doctor applies pressure to the front of the patient’s pelvis, at the hip bone, to see if this leads to pain.
The iliac compression test – which involves applying downward pressure on the top part of the pelvis to see if it generates pain.
The Gaenslen test – in which the doctor extends the hip while the patient lies down to stress the SI joint and see if it causes pain.
The thigh thrust test, which involves flexing the hip and then applying a rearward force to the SI joint.
The sacral thrust test, which requires applying forward pressure through the lower part of the spine while the patient lies face down.

The more of these tests that produce pain, the more likely it is that the sacroiliac joint is the source of the discomfort.

Testing for Sacroiliitis

If your doctor suspects that your sacroiliac (SI) joint pain could be due to inflammation, they might order blood tests. These can include a complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, human leukocyte antigen (HLA-B27), and rheumatoid factor. These tests can help identify the presence of inflammation in your body.

On the other hand, if your doctor thinks that cancer could be causing your SI joint pain – which is less common – they would order tests to check for that particular condition.

When your doctor analyzes the test results, they might discover that you have normal white blood cell count (except when there’s an infection), elevated erythrocyte sedimentation rate and C-reactive protein, and presence of HLA-B27 – a condition seen in about half to 92% of people with a type of arthritis called ankylosing spondylitis. The rheumatoid factor usually comes back negative in patients with true ankylosing spondylitis.

If your doctor doesn’t suspect inflammation or injury as the cause of your pain, they usually won’t order radiographic images or x-rays. But if they do decide to get these images, they can show changes in your SI joint due to age or disease. They can also use CT scans to show these changes, and any abnormal bone growths or abnormal movement. Magnetic Resonance Imaging (MRI) may show swelling in the bone below the cartilage of the SI joint, which is typically an early sign of sacroiliitis (inflammation of the SI joint). Positron Emission Tomography (PET) scans can be ordered if your doctor wants to check for cancer that could be spreading to the bones (metastatic disease).

The most useful test to diagnose sacroiliitis is a procedure where local anesthetics and steroids are injected into the SI joint. If this helps alleviate the pain, then the likely cause of the pain was inflammation at the specific site. The injection(s) could also potentially treat the pain altogether. If the injection helps significantly with the pain relief, even for a short time, it’s likely that the chronic pain is coming from your SI joint and in such cases, a surgical procedure can be considered. Ideally, no more than three of these injections should be done in a year.

Treatment Options for Sacroiliitis

If you’re experiencing pain due to too much flexibility or movement (hypermobility), physical therapy can be a big help. It aims to stabilize and strengthen the muscles in the lower back and pelvic region, which can help manage your pain.

On the other hand, if the discomfort is caused by stiffness or lack of mobility, then physical therapy can aid in increasing the movement of the Sacroiliac (SI) joint, which connects the spine to the hips.

During the early stages of your symptoms, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants might be prescribed. However, please note that these medications become less effective as the case progresses and becomes more chronic.

Another option for both diagnosing and reducing the discomfort is a procedure known as an image-guided intra-articular anesthetic/steroid injection. This involves using real-time imaging to guide a needle into the painful joint and injecting a local anesthetic along with a steroid to reduce inflammation and provide pain relief.

If the above treatments don’t provide enough relief, there’s an option called radiofrequency ablation. Some healthcare providers might consider this, where radio waves are used to reduce the nerve supply to the painful area hence reduce the pain.

If none of these treatments work and the chronic pain persists, surgery might be considered as a last resort. It usually involves Sacroiliac (SI) joint fusion, where parts of the SI joint are fused together with screws to limit movement and reduce pain.

When diagnosing certain conditions, the following potential causes or related problems also need to be considered:

Ankylosing spondylitis (a type of arthritis affecting the spine)
Hip tendonitis or fracture
Piriformis syndrome (a condition causing sciatica-like symptoms)
Sacroiliac joint infection (infection in the joint linking the lower spine and pelvis)
Trochanteric bursitis (inflammation of the bursa in the hip)