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Sacroiliitis

Sacroiliitis is a very painful disorder affecting one or both sacroiliac joints, located where the lower spine connects to the pelvis. It can lead to discomfort and stiffness in the lower back or buttocks, sometimes radiating down one or both legs. Prolonged sitting, standing, or climbing stairs may worsen the pain.

Symptoms

Sacroiliitis normally causes pain in the buttocks and lower back, though it can also extend to the groin, legs, and sometimes the feet. Movement may help alleviate discomfort, while certain activities can aggravate the pain, including:

  • Prolonged sitting or sleeping
  • Uneven weight distribution between the legs
  • Standing for extended periods
  • Climbing stairs
  • Running
  • Taking large strides when walking

Causes

Several factors can contribute to sacroiliitis, including:

  • Injury: An abrupt impact, like a fall or car accident, can harm the sacroiliac joints.
  • Arthritis: Osteoarthritis (wear-and-tear arthritis) can affect the sacroiliac joints just like ankylosing spondylitis, a form of arthritis impacting the spine.
  • Pregnancy: During pregnancy, the sacroiliac joints loosen to prepare for childbirth. The additional weight and changes in walking posture can put pressure on these joints.
  • Infection: Though rare, sacroiliac joints can get infected.

Risk Factors

Certain health conditions can elevate the likelihood of sacroiliac joint inflammation:

  • Inflammatory arthritis: Conditions such as psoriatic arthritis and ankylosing spondylitis may heighten the risk of sacroiliitis.
  • Inflammatory bowel disease: Ulcerative colitis and Crohn’s disease are likely to contribute to sacroiliac joint inflammation.
  • Pregnancy and childbirth: The physical changes that occur during pregnancy and delivery can strain the sacroiliac joints, leading to discomfort and swelling.

Diagnosis

Sacroiliitis can be diagnosed through:

  • Physical exam: The doctor will gently press on the buttocks and hips so as to identify areas of pain. Moving the legs into different positions can help assess stress on the sacroiliac joints.
  • Imaging tests: X-ray can reveal signs of sacroiliac joint damage, whereas MRI helps determine if the damage is related to ankylosing spondylitis.
  • Diagnostic injections: If an injection of numbing medication into the sacroiliac joint relieves the pain, it confirms the joint as the source of discomfort.

Treatment

Treatment for sacroiliitis depends on its cause and symptoms. Initial approaches often include stretching, strengthening exercises and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs).

Medications:

Based on the severity and cause of the pain, treatment options may comprise:

  • Pain relievers: Over-the-counter NSAIDs like ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) can help reduce pain and inflammation. If these are insufficient, a healthcare provider may recommend stronger pain medication.
  • Muscle relaxants: Medications like cyclobenzaprine (Amrix) may be taken to relieve muscle spasms associated with sacroiliitis.
  • Biologic drugs: These are used to treat autoimmune-related sacroiliitis. They include:
    • IL-17 (interleukin-17) inhibitors: Secukinumab (Cosentyx) and ixekizumab (Taltz).
    • TNF (tumour necrosis factor) inhibitors: Etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi).
  • Disease-modifying antirheumatic drugs (DMARDs): These help reduce inflammation and pain. Some, like tofacitinib (Xeljanz) and upadacitinib (Rinvoq), precisely target and block Janus kinase (JAK) enzymes.

Physical Therapy:

A physical therapist can guide patients through range-of-motion and stretching exercises in order to ease discomfort and maintain flexibility in the lower back and hips. Strengthening exercises can also help improve posture and protect the joints.

Surgical Procedures:

If other treatments fail to provide relief, the following options may be considered:

  • Joint injections: Corticosteroid injections can help ease pain and inflammation, though they are limited to a few per year to avoid weakening bones and tendons.
  • Electrical stimulation: Placing an electrical stimulator in the lower spine may be helpful in alleviating pain related to sacroiliitis.
  • Radiofrequency denervation: This procedure uses radiofrequency energy to destroy the nerve triggering the pain.
  • Joint fusion: Though rarely performed, surgery can fuse the sacroiliac joint using metal hardware to provide long-term pain relief.

Conclusion

While sacroiliitis can be a challenging condition, treatments are available to manage pain. The common options range from medications and physical therapy to advanced procedures. Early diagnosis and a tailored treatment plan can as well help improve mobility plus overall quality of life.

Book an appointment today to explore the best treatment plan for you.