Summary about Disease
Sacroiliitis is an inflammation of one or both of the sacroiliac (SI) joints, which are located where the lower spine (sacrum) connects to the pelvis (ilium). This inflammation can cause pain in the buttocks, lower back, groin, and even down the legs. Sacroiliitis can be caused by a variety of factors, including injury, arthritis, infection, and pregnancy. The severity and duration of symptoms vary widely.
Symptoms
The most common symptom is pain, typically located in the lower back or buttocks. Other symptoms may include:
Pain that radiates down the leg (similar to sciatica)
Pain that worsens with prolonged sitting or standing
Pain that is worse in the morning
Stiffness in the lower back and hips
Pain that increases with activities like climbing stairs, running, or twisting.
Pain may affect one or both sides, or alternate sides.
Causes
Sacroiliitis can arise from several factors:
Injury: Trauma to the SI joint due to a fall, car accident, or sports injury.
Arthritis: Different types of arthritis, such as ankylosing spondylitis, psoriatic arthritis, and osteoarthritis, can affect the SI joints.
Pregnancy: Hormonal changes during pregnancy can relax the ligaments in the SI joints, leading to instability and inflammation. The added weight also puts extra stress on the joints.
Infection: In rare cases, infection can directly affect the SI joint.
Unknown: Sometimes, the cause of sacroiliitis cannot be identified.
Gait problems: Leg length differences, abnormal walking patterns.
Medicine Used
Medications used to treat sacroiliitis aim to reduce pain and inflammation:
Pain relievers: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) can help alleviate mild to moderate pain. Stronger prescription pain relievers may be used for more severe pain.
Muscle relaxants: These medications can help relieve muscle spasms associated with sacroiliitis.
TNF inhibitors: Etanercept, adalimumab, infliximab, certolizumab pegol and golimumab are useful
Corticosteroids: Corticosteroid injections directly into the SI joint can provide temporary relief from pain and inflammation. Oral corticosteroids may also be prescribed, but are not usually used long-term due to side effects.
Disease-modifying antirheumatic drugs (DMARDs): If sacroiliitis is caused by an inflammatory arthritis like ankylosing spondylitis, DMARDs may be prescribed to slow the progression of the disease.
Physical Therapy: A combination of exercises and stretches.
Is Communicable
Sacroiliitis is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Precautions to help manage sacroiliitis and prevent flare-ups include:
Maintain good posture: Proper posture can help reduce stress on the SI joints.
Use proper lifting techniques: Bend your knees and keep your back straight when lifting heavy objects.
Maintain a healthy weight: Excess weight puts additional stress on the SI joints.
Regular exercise: Regular exercise, including strengthening and stretching exercises, can help support the SI joints and improve flexibility.
Avoid prolonged sitting or standing: Take breaks to stretch and move around if you have to sit or stand for long periods.
Use supportive shoes: Shoes with good arch support can help reduce stress on the SI joints.
Smoking Cessation: For inflammatory conditions, smoking cessation may help.
How long does an outbreak last?
The duration of a sacroiliitis outbreak varies greatly depending on the underlying cause, severity, and individual response to treatment.
Acute Sacroiliitis: An acute episode may last from a few days to a few weeks with appropriate treatment.
Chronic Sacroiliitis: Chronic sacroiliitis can persist for months or even years, with periods of flare-ups and remissions. Management focuses on long-term pain relief and preventing further joint damage.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical exam: The doctor will ask about your symptoms and medical history, and perform a physical exam to assess your range of motion, posture, and areas of tenderness.
Provocative tests: Specific physical maneuvers that stress the SI joints to see if they reproduce your pain.
Imaging tests:
X-rays: Can help rule out other conditions and may show signs of arthritis.
MRI (Magnetic Resonance Imaging): Provides more detailed images of the SI joints and can detect inflammation and other abnormalities.
CT scan (Computed Tomography): Can provide detailed images of the bones in the SI joints.
Diagnostic Injections: Injecting a local anesthetic into the SI joint. If the pain decreases, this can confirm that the SI joint is the source of the pain.
Timeline of Symptoms
The timeline of sacroiliitis symptoms can vary significantly, but a general progression might look like this:
Initial Onset: Sudden or gradual onset of pain in the lower back, buttocks, or groin.
Acute Phase: Pain may be constant or intermittent, and may worsen with certain activities.
Chronic Phase: If left untreated or poorly managed, the condition can become chronic, with persistent pain and stiffness that may wax and wane over time.
Flare-ups: Episodes of increased pain and inflammation can occur periodically, triggered by factors such as injury, overuse, or stress.
Important Considerations
Differential Diagnosis: It's crucial to rule out other conditions that can cause similar symptoms, such as herniated discs, spinal stenosis, and hip problems.
Individualized Treatment: Treatment should be tailored to the individual's specific needs and underlying cause of sacroiliitis.
Multidisciplinary Approach: A multidisciplinary approach involving doctors, physical therapists, and other healthcare professionals can be beneficial in managing sacroiliitis.
Long-Term Management: Chronic sacroiliitis requires ongoing management to control pain, prevent flare-ups, and maintain function.
Early Intervention: Early diagnosis and treatment can help prevent the condition from becoming chronic and improve long-term outcomes.