Sacroiliitis is an inflammation of one or both of your sacroiliac joints — situated where your lower spine and pelvis connect. Sacroiliitis can cause pain in your buttocks or lower back, and can extend down one or both legs. Prolonged standing or stair climbing can worsen the pain. Sacroiliitis can be difficult to diagnose, because it can be mistaken for other causes of low back pain. It's been linked to a group of diseases that cause inflammatory arthritis of the spine. Treatment might involve physical therapy and medications.
What are the Symptoms of Sacroiliitis
The pain associated with sacroiliitis most commonly occurs in the buttocks and lower back. It can also affect the legs, groin and even the feet. Sacroiliitis pain can be aggravated by:
- Prolonged standing
- Bearing more weight on one leg than the other
- Stair climbing
- Taking large strides
What are the Causes of Sacroiliitis
Causes for sacroiliac joint dysfunction include:
- Traumatic injury. A sudden impact, such as a motor vehicle accident or a fall, can damage your sacroiliac joints.
- Arthritis. Wear-and-tear arthritis (osteoarthritis) can occur in sacroiliac joints, as can ankylosing spondylitis — a type of inflammatory arthritis that affects the spine.
- Pregnancy. The sacroiliac joints must loosen and stretch to accommodate childbirth. The added weight and altered gait during pregnancy can cause additional stress on these joints and can lead to abnormal wear.
- Infection. In rare cases, the sacroiliac joint can become infected.
Diagnosis of Sacroiliitis
During the physical exam, your doctor might try to pinpoint the cause of your pain by pressing on places on your hips and buttocks. He or she might move your legs into different positions to gently stress your sacroiliac joints.
- Imaging tests
An X-ray of your pelvis can reveal signs of damage to the sacroiliac joint. If ankylosing spondylitis is suspected, your doctor might recommend an MRI — a test that uses radio waves and a strong magnetic field to produce very detailed cross-sectional images of both bone and soft tissues.
- Anesthetic injections
Because low back pain can have many causes, your doctor might suggest using numbing injections (anesthetics) to help with the diagnosis. For example, if such an injection into your sacroiliac joint stops your pain, it's likely that the problem is in your sacroiliac joint. However, the numbing medicine can leak into nearby structures, and that can reduce the reliability of this test.
Treatment of Sacroiliitis
Treatment depends on your signs and symptoms, as well as the cause of your sacroiliitis.
Medications of Sacroiliitis
Depending on the cause of your pain, your doctor might recommend:
- Pain relievers. If over-the-counter pain medications don't provide enough relief, your doctor may prescribe stronger versions of these drugs.
- Muscle relaxants. Medications such as cyclobenzaprine (Amrix, Fexmid) might help reduce the muscle spasms often associated with sacroiliitis.
- TNF inhibitors. Tumor necrosis factor (TNF) inhibitors — such as etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) — often help relieve sacroiliitis that's associated with ankylosing spondylitis.
Therapy of Sacroiliitis
Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to maintain joint flexibility, and strengthening exercises to make your muscles more stable.
Changing one's 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. 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.