Sacroiliitis

Sacroiliitis is the condition in which one or both sacroiliac joints, which connect the lower spine and pelvis, swell up. It is the common cause of pain in buttocks or lower back and can extend to one or both legs.

The sacroiliac (SI) joint provides very less movement than the hip or knee joint. The main function of this joint is to offer shock absorption to the spine through the gliding type motion.

Sacroiliitis characterized by the inflammation of the SI joint, and is mostly caused due to degenerative arthritis, severe injury, vehicle accident, or a hard blow to the buttock or pelvic area.

Women are at more of a risk when it comes to suffering from sacroiliitis, since the pelvic area of a woman stretches wide enough to allow child birth.

The ligaments that are around the joint and connect one bone with the other may get torn or inflamed.  The tearing of these ligaments can cause a lot of motion in the joint which leads to degenerative changes and chronic pain. 

It is difficult to diagnose because it is commonly mistaken for other causes of low back pain. Inflammatory arthritis of the spine has been linked to sacroiliitis. Physiotherapy and some medications are the most commonly used treatment methods.

Signs and symptoms associated with sacroillitis include the following: 

• Buttock pain:  This is usually a dull pain that is experienced on one side of the lower back. This pain can radiate down the thighs or groin of the effected side.
• Lower back pain: This is one of the most common pain problems in America and occurs due to various factors. More than 85% of lower back pain cases are non specific, which means that they cannot be attributed to one particular spinal disease. Lower back pain that is linked to the SI joint is like a dull pain on one side of the lower back. The sacroiliac joint is the cause of lower back pain in about 13 – 31% of patients.
• Hip and shoulder pain: SI pain can manifest itself in the hip and shoulder.
• Stiffness: Typically this is felt in the hip and lower back, especially while getting out of bed in the morning or sitting in one position for very long.
• Redness: Typically this is seen near the joint accompanied by lessened movement of the joint.

These symptoms increase by prolong standing, bearing more weight on one leg than other, climbing stairs, running, and taking large strides when walking.

Traumatic injury is one of the most common cause of sacroiliitis. A sudden impact such as motor vehicle accident or fall from a considerable height causes damage to the sacroiliac joint. 

Other causes include:

• Arthritis: Osteoarthritis that occurs in the sacroiliac joint (ankylosing spondylitis) can also show symptoms similar to sacroiliitis
• Pregnancy: The sacroiliac joints must stretch and bear the weight of the child. The altered gait during pregnancy caused additional stress on these joints
• Infection: Some rare cases of sacroiliac joint infection have been reported
• Heavy lifting: If one lifts heavy objects, especially if it is lifted incorrectly, or if the muscles were not prepared for this activity
• Pregnancy: The sacroiliac joints have to loosen up and stretch to allow childbirth. The weight gain and altered gait during pregnancy can add to stress on these joints and cause abnormal wear
• Osteomyelitis
• Urinary tract infection
• Endocarditis
• IV drug use/drug addition

Doctor’s appointment preperation:

Initially, patients who are experiencing pain in the lower back, hips, and buttocks are likely to visit their primary care provider. The doctor will refer them to a rheumatologist or an orthopedic surgeon for further diagnosis and treatment.

While meeting with your doctor:

Ask if there is anything that needs to be done prior to appointment: For example, fasting if any tests are to be conducted.

Make a list of the following;

• Symptoms: List down all the symptoms that could be related to the problem. It is advisable to make a note of these as they occur. These signs and symptoms will help the doctor find the root cause of the problem.
• Personal information: Make a note of all the personal information which can include major stresses, recent life changes if any, family and personal medical history, especially if anyone in immediate family has or had similar symptoms.
• Medications: Also keep a note of all medications, vitamins, and other supplements you are taking.

Some of the questions you can ask your doctor include:

• What are the factors that are causing the symptoms?
• What are the causes for the developing this condition?
• What tests are required?
• Is the current condition a temporary orchronic problem?
• What's the best course of action when it comes to treatment?
• What are the treatment alternatives available to the approach the doctor is suggesting?
• How can I manage this condition in a way that works with my lifestyle?
• Are there any particular restrictions that need to be followed?
• Is there a need to visit a specialist?
• Are there any brochures or other printed material that I can refer to once the appointment is finished?
• Are there are reliable websites I can refer to?

Things to expect from your doctor

The doctor is likely to first gather some information by asking you the following questions:

• When did the symptoms first begin?
• Are the symptoms continuous or occasional?
• Where is the exact location of the pain?
• How severe is the pain?
• Does any activity worsen or reduce the pain?

Diagnosis in case of sacroiliitis is done by an orthopedist. He or she will perform a physical examination by pressing on the hips and buttocks and try to understand the cause of pain. 

The doctor would also try to move the legs in different directions to gently stress the sacroiliac joints.

The following tests are recommended by a doctor: 

• Imaging test:  The X-ray of the pelvis area is done to identify any signs of damage to the sacroiliac join. And if the doctor suspects ankylosing spondylitis, he/she may suggest an MRI scan, which is a test that makes use of radio waves and a strong magnetic field to provide a detailed cross-sectional images of the bone as well as the soft tissues.
• Anesthetic injections: Since low back pain can be linked to a lot of causes, the doctor may recommend using a numbing injection (anesthetics) to help reach a proper diagnosis. For instance if by giving an anesthetic injection in the sacroiliac joint the pain goes away, it is possible that the pain is in the sacroiliac joint. But the anesthetic injection can affect the nearby area and therefore reduce the reliability of the diagnosis and test. 

Treatment depends on the severity and the cause of sacroiliitis.

Treatment includes: 

• Medications: Depending on the cause of pain the doctor might recommend pain relievers (generally over the counter pain medications provide relief but sometimes stronger medications are required), muscle relaxants (they help to reduce the muscle spasms associated with sacroiliitis) and TNF inhibitors (tumor necrosis factor inhibitors that often help to relieve sacroiliitis associated with ankylosing spondylitis). 
• Physiotherapy: The doctor may also recommend a physiotherapy session which can help to increase range of motion and maintain joint flexibility. The physiotherapist would perform some stretching exercises to increase the stability of the muscle. 
• Surgery: If the above mentioned methods do not help, then joint injections might be used. Injections such as corticosteroids are injected directly into the joint to reduce pain and swelling. These injections are to be taken in a limited amount because they can weaken the tendons, joints, and bones. 
• Radiofrequency denervation: An electrical stimulator is implanted into the sacrum to reduce the pain.
• Joint fusion: A rarely used procedure to fuse two bones together with metal hardware can sometimes relieve pain.

In order to prevent sacroiliitis cause by inflammatory arthritis, early diagnosis and treatment is important. 

Another major preventive factor is to prevent traumatic injuries of the spinal cord and hips. Support to the muscles of pelvis and lower back can prevent development of sarcoiliitis during pregnancy. It is recommended to seek help of a physiotherapist during this time.

Due to the severity of pain caused by sacreoiliitis, some home remedies are recommended before visiting a doctor:

• Over the counter pain relievers like ibuprofen and acetaminophen may help to reduce the pain associated with sacroiliitis. Although these drugs are known to cause peptic ulcers, kidney problems, or liver problems, they are still widely used and they should be taken as directed by the physician or as written on the labels. 
• Avoiding activities that increase the pain and having plenty of rest may improve the condition.
• Maintaining proper posture is important if you have this condition.
• Alternate application of ice and heat may relieve pain.

Lifestyle modifications are necessary in order to cope with sacroiliitis.

Improving your sleep position can help alleviate pain due to sacroiliitis. Increasing the time of rest may help to calm the inflamed sacroiliac joints. 

Avoid standing for a long time, running, standing on one leg for long time, and climbing stairs since such activities tend to aggravate the pain of sacroiliitis.

There are several risks and complications associated with sacroiliitis.

The risk factors of sacroiliitis include:

• Age: Older people are more predisposed to sacroiliitis because of higher chances of arthritis.
• Menopause: After menopause, due to hormonal imbalance, are at higher risk of arthritis and therefore for sacroiliitis. 
• Pregnancy: Due to increased weight and altered gait after pregnancy, women can develop this condition. 

Sacroiliitis is a chronic condition leading to long term pain which can result in depression and insomnia.