Sacroiliitis falls under a group of conditions called spondyloarthropathies: inflammatory conditions of the spinal column. Other spondyloarthropathies include ankylosing spondylitis, reactive arthritis, enteropathic spondyloarthritis, axial spondyloarthritis, and psoriatic arthritis. These conditions all involve inflammation of the bones in the spine and the adjacent joints. Spondyloarthropathies cause varying degrees of pain and limitations in movement.
Sacroiliitis is inflammation in the sacroiliac joint, the space between the iliac bone in the hip and the sacrum in the lower spine. When the joints are inflamed, it can cause pain and stiffness, particularly in certain movements. The symptoms may start with a joint that is injured or doesn't work as well as it should, and then inflammation sets in. Research suggests between 10% and 25% of all lower back pain is related to sacroiliitis.
Sacroiliitis is frequently associated with damage to the sacroiliac joints from other joint conditions or from direct injury. Causes include other spinal problems, trauma during pregnancy or delivery, and inflammation in the joints from other conditions such as arthritis, gout, or ankylosing spondylitis.
The biggest risk factor for sacroiliitis is injury to the sacroiliac joint from trauma or inflammation. However, women may develop sacroiliitis during pregnancy. The hormonal changes associated with pregnancy cause the joints to loosen and stretch to prepare for the passage of the baby. As the baby grows in the womb, it changes a woman's gait and this also contributes to inflammation in the sacroiliac joint.
The most common symptom of sacroiliitis is pain and stiffness in the lower back, hip, buttock, or leg. The symptoms become more pronounced after sitting for a while and then rising from a chair. The pain may worsen when making a sudden movement in bed, leading to lost sleep. The discomfort is also usually more pronounced when getting out of bed in the morning. A low-grade fever is another sign of sacroiliitis and comes from inflammation.
Physical examination is important for diagnosing sacroiliitis. A healthcare provider will apply direct pressure to the sacroiliac joint and see if it causes pain. They may also move your legs in various directions to see if these movements cause pain in the sacroiliac joints. They may recommend x-rays or more advanced imaging, like MRI, to look for damage to the sacroiliac joints.
The most common treatments for sacroiliitis are medications to ease pain and stiffness and exercise or physical therapy. Gentle stretching exercises help relieve stiffness in the muscles and joints. Healthcare providers sometimes recommend sessions with a physical therapist to stretch and strengthen the muscles that lie over the sacroiliac joints. This can improve stiffness and physical function.
Doctors sometimes prescribe non-steroidal anti-inflammatory medications to reduce inflammation in the sacroiliac joint and reduce pain. For stiffness or tightness in the back or buttocks, they may recommend a muscle relaxant. If the pain is severe or interferes with daily activities, they may offer more potent pain medication. The medications they prescribe will depend on how significant the symptoms are and how much they interfere with daily activities.
Surgery is an uncommon treatment for sacroiliitis but may be an option in cases that don't respond to other treatment. The surgery involves holding together the two bones that make up the joint with a metal plate.
More commonly, doctors recommend advanced non-surgical treatments for unresponsive cases. These might include injection of corticosteroids into the joint to relieve pain. However, there are downsides to doing this. Another treatment is targeting the nerves causing the pain with radiofrequency, which damages them.
At-home treatments include gentle stretching to relieve tightness over the sacroiliac joint. Applying ice or alternating ice and heat may reduce inflammation and increase blood flow to the area. Relaxation exercises, controlled breathing, and meditation can be beneficial for reducing pain. It's also important to find a balance between movement and rest, not overexerting but including gentle movement to avoid stiffness.
If sacroiliitis comes on suddenly because of an injury or pregnancy, it may respond quickly to conservative therapy like medications and stretching. If there's damage to the joints, sacroiliitis can become a chronic or recurring problem, and if it interferes with activity, it can lead to muscle weakness and atrophy. However, most cases of sacroiliitis can usually be managed through physical therapy, lifestyle changes, and medications.
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