Sacroiliitis: Causes, Symptoms, Risk Factors & Treatment Options
It is considered to be inflammation of one or both sacroiliac joints. These joints connect the lower spine to the pelvis and are weight bearing joints.
Sacroiliits will cause pain and stiffness in the buttock region and lower back, this pain might also radiate and go down one or both legs. Exacerbation of the pain will happen after sitting or standing for long duration of time. Also movement of the hip joint such as when climbing stairs will make the pain worse.
Sacroiliits is very tricky to diagnose. It is usually mistaken for other causes of low back pain such as muscle pain, disc disease.
Sacroiliits might present on its own or might be linked to a group of diseases that cause inflammation in the whole spine ( Ankylosing spondylitis).
Most of the time, it can be treated with medications such as analgesics, anti-inflammatory medications and we combine with with physical therapy in order to get long lasting relief for the patients.
How does the patient present?
He will be complaining of pain the buttocks and lower back. The pain can go to the legs, groin and even feet. The pain will get reduced with activity.
The patient would report more pain with sitting, sleeping or standing for a long time. It is not unusual to mention that there is more pain by putting more weight on one lower limb than the other.
Daily activities include stair climbing, running, taking large steps will cause pain.
What causes Sacroiliitis?
Trauma: such as a fall, being involved in a motor vehicle accident
Arthritis: Degenerative and wear and tear osteoarthritis that affects large weight bearing joints
Pregnancy: Widening and stretching of the sacroiliac joints along with the added weight during pregnancy can stress those joints.
Infection: Very rare entity but possible and can happen as with any joint.
What are risk factors for sacroiliitis?
Inflammatory forms of arthritis such as ankylosing spondylitis and psoriatic arthritis
Inflammatory bowel diseases including Crohn’s diease and ulcerative colitis
Pregnancy
What are risk factors for sacroiliitis?
Limitations in bending , lifting, staying in one position and rising from a chair.
Long term pain can lead to depression and loss of sleep
How to diagnose Sacroiliitis?
History and physical examination by an orthopedic surgeon or rheumatologist
Imaging such as radiographs and MRI will show the damage in the joint from ongoing inflammation
Administration of anesthetic to the joint can act as diagnostic modality to make sure the patient has sacroiliitis
How to treat Sacroiliitis?
Initially it will consist of medications such as NSAIDS and undergoing a structured physiotherapy program.
Physiotherapy aim is to stretch and strengthen the muscles around the hip and pelvis.
Medications used to reduce inflammation can range from Analgesics to NSAIDS to muscle relaxants.
Biologics and Disease-modifying antirheumatic drugs (DMARDs) are used in case where sacroiliitis is part of autoimmune rheumatological disease.
Invasive modalities for treating the Sacroiliitis?
Corticosteroid injection into the joint fluoroscopy or ultrasound guided can reduce the pain and swelling but repeated injections are contra-indicated since they will damage the joint by weakening the bones and tendons.
Electrical stimulation: Implanting a pain pump in the lower spine could reduce the pain from sacroiliitis but this also is slef limiting since the pump needs to be changed every three to five years.
Sacroiliac joint fusion: Surgery for the sacroiliac joint is rarely performed but is indicated in patients with sacroiliitis who have tried everything with no success. It consists of fusing both bones of the joint using metal hardware (screws). This ultimately will reduce the inflammation and pain.
Dr. Marc Najjar, Consultant Orthopedic Surgeon & Consultant Spine Surgeon performed the first sacroiliac joint fusion procedure in Dr Sulaiman al Habib hospital Dubai for a patient who exhausrted all other options.
She underwent the procedure using a minimally invasive technique.
Dr. Marc Najjar inserted two Sacroiliac joint screws using the Orthofix SI fuse system.
The patient had marked reduction in her sacroiliac joint pain at the two weeks visit and is in the process of undergoing physiotherapy.
She will get her life back and start exercising to lose weight.
