Dr. Wolfe has been in the practice of pain management since 1992.

- MidOhio PainCare

Sacroiliitis

What Is Sacroiliitis?

Sacroiliitis is inflammation or irritation of the sacroiliac joint, which connects the lower spine and sacrum to the pelvis. It is often a result of degenerative arthritis, but may come from gait abnormalities or trauma. It can be associated with an inflammatory spondyloarthropathy, basically any disease that can cause inflammatory arthritis of the spine. It causes buttock pain that can be made worse by movement. It may irritate the underlying sciatic nerve and cause sciatica as well.

What Causes Sacroiliitis?

In most cases, sacroiliitis results from a gradual, degenerative aging process. Either structural changes or inflammation can begin the process. As people age, the ligaments around the sacroiliac joint may thicken and calcify. The surrounding bones and the sacroiliac joint may also enlarge. When surfaces of the bone begin to project out from the body, these bone spurs are called osteophytes. Thus for most older patients the sacroiliitis come from degenerative arthritis.

Osteoarthritis is the most common form of arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process that may involve multiple joints of the body. It wears away the surface cartilage layer of joints, and is often accompanied by overgrowth of bone, formation of bone spurs, and loss of function. If the degenerative process of osteoarthritis affects the sacroiliiac joint, the condition is referred to as sacroillitis.

In some patients, sacroiliitis may come from trauma or overuse. Some cases do not actually involve the joint, but rather are mostly injury or inflammation in the surrounding ligaments and soft tissue. The sacroiliac joint is surrounded by a large amount of ligamentous and fibrous tissue for added stability. When these tissues are injured, signs and symptoms may be identical to sacroiliitis.

A rare cause of sacroiliitis is infection of the sacroiliac joint or a reaction from a recent gastrointestinal bacterial infection. Other diseases like Crohn's disease, ulcerative colitis, psoriasis, ankylosing spondylitis and others are all associated with developing sacroiliitis.

What Are the Symptoms Of Sacroiliitis?

Signs and symptoms of sacroiliitis depend on the underlying cause. When the cause is degenerative change or overuse the patient may have pain and stiffness in the lower back or buttocks, especially in the morning. There may also be stabbing pain with twisting or bending or rolling over in bed. In cases where
sacroiliitis comes as the result of an infection, there will not only be buttock symptoms but there also could be other inflamed joints, inflammation in the eye, or bloody diarrhea. In rare cases, sacroiliitis is also associated with psoriasis.

What Are Some Nonsurgical Treatments For Sacroiliitis?

In the absence of severe or progressive nerve involvement, the doctor may prescribe nonsteroidal anti-inflammatory drugs, such as aspirin, naproxen, ibuprofen, or others to reduce inflammation and relieve pain. Analgesics, such as acetaminophen, tramadol or narcotics may be prescribed to relieve pain. The doctor may order physical therapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. Some patients may be encouraged to try an exercise program, aquatics or chiropractic. Corticosteroid injections into the sacroiliac joints space may be performed to reduce inflammation and treat severe pain.

In cases where the sacroiliitis comes from infection, antibiotics will be used. If the sacroiliitis comes from an inflammatory spondyloarthropathy, specific medications directed at the underlying condition may be used under the direction of a rheumatologist.