Article Featured on Spine Health | By Amish Patel, MD | Image Credit: Veritas Health
The term sacroiliitis is used to describe any inflammation in the sacroiliac joint, which is located on either side of the sacrum (lower spine) that connects to the iliac bone in the hip.
Sacroiliitis is often found as part of a feature of inflammatory conditions of the spinal column. As a group, these conditions and diseases are termed a “spondyloarthropathy” and include conditions such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, among others.
Sacroiliitis may also be a component of other types of arthritis, such as ulcerative colitis, Crohn’s disease, or osteoarthritis.
Sacroiliitis is also a term that is sometimes used interchangeably with the term sacroiliac joint dysfunction, as technically either term can be used to describe pain that stems from the sacroiliac joint (or SI joint).
Sacroiliitis vs. Sacroiliac Joint Dysfunction
Both sacroiliitis and sacroiliac joint dysfunction are a common cause of sacroiliac pain, low back pain, and leg pain.
However, there are differences between the two conditions:
- Sacroiliitis. In medicine, the term “itis” refers to inflammation, and sacroiliitis describes inflammation of the sacroiliac joint. The inflammation may or may not be caused by sacroiliac joint dysfunction.
- Sacroiliac Joint Dysfunction. This condition generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the SI joint, or sacroiliitis.
The most common symptoms of sacroiliitis include some combination of the following:
- Pain, usually low back pain, leg pain (may be in the front of the thigh), hip pain, and/or buttock pain
- Pain that is worse when sitting for a long time, and worse when rolling over in bed
- Stiffness felt in the hips and low back, especially after getting out of bed in the morning or after sitting still for a prolonged period.
A wide range of factors may cause sacroiliitis or predispose one to developing sacroiliitis:
- Any form of spondyloarthropathy, which includes ankylosing spondylitis, arthritis associated with psoriasis, and other rheumatologic diseases, such as lupus
- Degenerative arthritis, or osteoarthritis of the spine, causing degeneration of the sacroiliac joints and in turn leading to inflammation and SI joint pain
- A trauma that affects the lower back, hip or buttocks, such as a car accident or fall
- Pregnancy and childbirth, as a result of the pelvis widening and stretching the sacroiliac joints during childbirth
- Infection of the sacroiliac joint
- Urinary tract infection
- IV drug use/drug addition
If a patient has pain in the sacroiliac area and any of the above conditions, he or she may have sacroiliitis or sacroiliac joint dysfunction.
The specific sacroiliitis treatments will be determined primarily by the type and severity of the patient’s symptoms, and the underlying cause of the sacroiliitis.
There is a wide range of nonsurgical options available. Most patients find that a combination of two or more of the following nonsurgical treatments can be effective in managing their symptoms:
A short period of rest may help calm the inflamed sacroiliac joints.
Heat and/or ice
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.
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.
For many, over-the-counter pain medications, such as acetaminophen, and/or anti-inflammatory medications, such as ibuprofen, provide sufficient pain relief. Prescription medications may be recommended, such as tramadol (brand name Ultram), or a short course of narcotic pain medications, or muscle relaxants to help reduce painful muscle spasms.
Sacroiliac joint injections
For severe pain, a sacroiliac joint injection may be recommended both to confirm the sacroiliac joint as the source of the pain and to introduce the anti-inflammatory medication directly into the joint. The injection is done with fluoroscopic guidance, which is a type of live x-ray, to ensure correct placement of the needle in the joint. The injection typically includes both a numbing agent, such as lidocaine, and a steroid, which is a strong anti-inflammatory medication.
Injections can typically be done up to three to four times in one year, and should be accompanied by physical therapy and/or chiropractic or osteopathic manual manipulation to restore proper range of motion and rehabilitation.
A prescribed physical therapy program of stretching, strengthening and low impact aerobic conditioning is usually a part of most sacroiliitis or sacroiliac joint dysfunction treatment regimens. The therapy may be done by a physical therapist, chiropractor or other appropriately trained health specialist.
Other Sacroiliitis Treatments
As part of treatment for another condition
If sacroiliac joint mediated pain is a result of another condition, (such as ankylosing spondylitis, osteomyletis, etc.), then additional treatments will focus on treating the underlying cause of the SI joint symptoms as well.
Sacroiliac joint surgery
The vast majority of cases of sacroiliac joint mediated pain are treated with nonsurgical options. For severe, intractable pain that is unresponsive to nonsurgical options and interferes with the patient’s everyday life, surgery may be considered an option. The surgery is a sacroiliac joint fusion, which is designed to fuse the SI joint to stop the motion in the joint.
New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.