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Sacroiliitis is an inflammation affecting one or both sacroiliac joints. It is a common cause of lower back pain, buttock pain, and thigh pain.
The sacroiliac joints are located where the sacrum (lower spine) and ilium (pelvis) meet. When either of these joints becomes swollen, it can cause stiffness and pain in the lower back and buttocks as well as in one or both legs. Standing or sitting for an extended period of time and climbing stairs can worsen the pain. Sacroiliitis can be caused by trauma, pregnancy, infection, or an underlying medical condition. It is often difficult to diagnose as many other illnesses can cause pain in the same area of the body. It is managed through medication and physical therapy. If left untreated, it can lead to a loss of mobility.
Symptoms
The most common symptom of sacroiliitis is pain felt in the legs, foot, and groin, but most often in the buttocks and lower back. Physical activity can help reduce the pain associated with sacroiliitis. However, the following action may worsen the discomfort:
- Being heavier on one leg than the other.
- Spending long periods of time sleeping or sitting.
- Spending long periods of time standing.
- Running or walking with long strides.
- Going up and down the stairs.
- After rotating the hips.
Visit a healthcare provider if pain in the lower back, buttocks, or thighs persists. A proper diagnosis is necessary for correctly treating or managing the pain.
Causes
Sacroiliitis can develop due to various reasons, including:
- Injury: Trauma to the sacroiliac joints or the ligaments that support or surround these joints, caused by a fall, car accident, or other incidents, can lead to sacroiliitis.
- Arthritis: Chronic illnesses such as psoriatic arthritis, osteoarthritis, and ankylosing spondylitis can result in inflammation of the sacroiliac joint. Psoriatic arthritis is an inflammatory condition that causes joint pain and swelling along with psoriasis. Osteoarthritis, on the other hand, is a form of wear-and-tear arthritis that can develop in the sacroiliac joints and is caused by the breakdown of ligaments. Ankylosing spondylitis is a type of inflammatory arthritis of the joints of the spine. Sacroiliitis is often an early symptom of ankylosing spondylitis.
- Pregnancy: During pregnancy, the extra weight and altered walking pattern can put pressure on the sacroiliac joints, and the hormones produced can cause the pelvic muscles and ligaments to loosen, resulting in the twisting of the sacroiliac joint.
- Infection: Pyogenic sacroiliitis, an unusual sacroiliac joint infection caused by the bacteria Staphylococcus aureus, can also result in sacroiliitis.
Diagnosis
The diagnosis of sacroiliitis may involve assessment of medical history, particularly any past inflammatory illnesses or ailments, perform of physical examination and several tests.
- Physical examination: During the physical exam, the spine is evaluated for correct alignment and rotation. Patients are positioned or instructed to move in specified directions throughout various physical movement assessments. Changing leg postures softly stresses the sacroiliac joints. The doctor may apply pressure to the sacroiliac joint, spine, hip, or leg during some of these examinations.
- Imaging tests: To determine the source of the pain or to investigate any abnormalities in the sacroiliac joint, the doctor may request X-rays, Computed tomography (CT) scans, or Magnetic resonance imaging (MRI) scans. An MRI can help determine if the damage is caused by ankylosing spondylitis, while an X-ray of the pelvis can show evidence of sacroiliac joint damage.
- Blood test: A blood test is conducted to detect sign of inflammation.
- Steroid injection: A steroid injection into the sacroiliac joint serves as both a diagnostic tool, if it alleviates the pain, and a form of treatment. The procedure utilizes x-ray imaging to guide the spinal needle to the correct injection site.
Treatment
Common treatment for sacroiliitis include medication and physical therapy. The initial treatment for sacroiliitis often involves over-the-counter nonsteroidal anti-inflammatory pain relivers and strengthening exercises. However, the appropriate treatment plan is determined based on the symptoms and cause of the sacroiliitis.
- Medicines: Depending on the cause of the pain, medications may include:
- Pain relievers: Over-the-counter nonsteroidal anti-inflammatory pain relievers include ibuprofen and naproxen sodium. In the case that these do not provide sufficient pain relief, a healthcare professional may prescribe a more potent pain reliever.
- Muscle relaxers: Certain medications, such as cyclobenzaprine, may help lessen the muscle spasms associated with sacroiliitis.
- Biologics: Biologic drugs are used in the treatment of various autoimmune disorders. Secukinumab (Cosentyx) and ixekizumab (Taltz) belong to the group of interleukin-17 (IL-17) inhibitors, while etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and golimumab (Simponi) are classified as tumor necrosis factor (TNF) inhibitors. Both categories of biologics can be used to relieve the symptoms of sacroiliitis.
- Therapy: Physical therapy is often beneficial for those with sacroiliitis. This treatment strengthens and stabilizes the muscles surrounding the sacroiliac joints as well as helps the joints move through their full range of motion. Range-of-motion and stretching exercises are used to relieve pain and maintain flexibility in the lower back and hips, while strengthening activities improve posture and protect the joints. These exercises should be performed under the guidance of a physical therapist.
Range-of-motion and stretching exercises are used to relieve pain and maintain flexibility in the low back and hips, while strengthening activities improve posture and protect the joint. These exercises should be performed under the guidance of a physical therapist.
- Surgical and other procedures:
If previous treatments have not effectively reduced pain, a healthcare provider may recommend:- Joint injection: Steroids may be injected into the joint to decrease inflammation and alleviate pain. However, it is limited to a few injections per year as steroids can weaken bones and tendons in the surrounding area.
- Radiofrequency ablation: This method uses radio waves to heat a small area of nerve tissue, thereby blocking pain signals and relieving pain.
- Spinal electrical stimulation: The implantation of an electrical stimulator in the lower spine may help ease pain caused by sacroiliitis.
- Joint fusion surgery: Although it is a rare treatment option for sacroiliitis, fusing the two bones together using metal devices can reduce discomfort.
