Sacroiliitis and Sacroiliac Joint Pain

What is sacroiliitis, degenerative sacroiliitis, and can it cause or contribute to sacroiliac joint dysfunction?

Sacroiliitis is inflammation of one or both of your sacroiliac (SI) joints. Because of its connection to degenerative changes in the spine, your doctor may refer to your condition as degenerative sacroiliitis. Sacroiliitis can cause painful sacroiliac joint dysfunction.

What Is Sacroiliitis?
Sacroiliitis affects your SI joints, which connect your sacrum in your lower spine to your pelvis. It is characterized by painful inflammation throughout your low back and buttocks, and may travel down through your lower extremities.
Young woman holding her low back, in pain.Sacroiliitis is characterized by painful inflammation throughout your low back and buttocks.Sacroiliitis may be caused by certain types of spinal inflammatory arthritis, including ankylosing spondylitis and spondylosis (spinal osteoarthritis). Sometimes, the presence of sacroiliitis is an early sign of these degenerative conditions.

While degenerative changes can cause sacroiliitis, SI joint inflammation can also be caused by the following non-degenerative events:

  • Trauma: Injury that damages your SI joints can trigger inflammation.
  • Pregnancy: The SI joints stretch to accommodate the growing baby, which may pressure and inflame the joints.
  • Infection: Infection in the SI joints can produce inflammation around the joints.

Sacroiliitis Symptoms
Sacroiliitis produces pain in your lower extremities—from your low back to your buttocks, and sometimes down through one or both legs. Many people with sacroiliitis also report stiffness in their lower spine and hips.

People with sacroiliitis often experience pain that worsens during certain activities, including:

  • Standing or sitting for long periods
  • Climbing stairs
  • Standing on one leg
  • Running
  • Rolling over in bed

Diagnosing Sacroiliitis
Because the symptoms of sacroiliitis are similar to other causes of low back pain, it can be challenging to diagnose.

To get to the bottom of your pain, your doctor starts with a review of your medical history and performs a physical and neurological exam. Doctors often detect SI joint dysfunction by having you lie on your back and moving your legs in different ways that places pressure on your SI joints. If you report pain during these sacroiliac joint maneuvers, it could be an indication that one or both SI joints are the source of your pain.

To help confirm that one or both of your SI joints is a pain generator, your doctor will administer a diagnostic sacroiliac joint injection. This type of injection delivers numbing medicine into the joint(s). If you experience relief after the injection, that’s a good sign the SI joint is a pain generator.

While physical exams and diagnostic injections may be enough to diagnose SI joint dysfunction, an imaging test may be needed to show if sacroiliitis is the true cause of the dysfunction. Damage caused by inflammation around the SI joints may show up in magnetic resonance imaging (MRI), computed tomography (CT), and plain x-ray scans to confirm the diagnosis.

Non-Surgical Treatment for Sacroiliitis
Sacroiliitis can be extremely painful, but most people find that non-surgical methods are effective at managing their symptoms.

Home treatments and physical therapy

  • Rest: First-line treatment of sacroiliitis often includes rest. Rest helps reduce inflammation, while preventing you from engaging in activities that might worsen your pain.
  • Ice and Heat: Your doctor may recommend you alternative between ice and heat therapy. Using an ice pack for acute pain relief and heat later can help calm pain.
  • Physical therapy: For longer-term relief and possible pain prevention, your doctor may refer you to physical therapy to learn specific exercises that target and strengthen the SI joints and surrounding muscles. Strengthening the structures can help make them more stable and less susceptible to future pain.

A wide spectrum of medication may be recommended based on your symptoms and their characteristics (eg, acute, episodic).

  • Pain relievers: Over-the-counter pain medications, including non-steroidal anti-inflammatory drugs (NSAIDs), may help reduce pain and inflammation. If over-the-counter options aren’t helping, your doctor may prescribe you a prescription pain reliever.
  • Muscle relaxants: You may experience muscle spasms because of SI joint inflammation. Your doctor can prescribe a muscle relaxant, such as baclofen or carisoprodol, to help ease the pain by reducing spasms.
  • TNF inhibitors: TNF inhibitors, including etanercept and infliximab, are a complex class of medications that may help if your sacroiliitis is connected to spinal inflammatory arthritis.

Other non-surgical therapies
If conservative, at-home approaches aren’t providing relief, your doctor may recommend the following treatment:

  • Bipolar radiofrequency neurotomy (or radiofrequency ablation): This minimally invasive procedure disables and prevents specific spinal nerves from sending  pain signals.
  • SI joint injections: Injections are used during the diagnostic process, but they also help treat sacroiliitis by sending powerful an anti-inflammatory agent directly to the affected SI joints.

Fusion Surgery for Sacroiliitis
If you have tried several non-surgical therapies with no success, it may be time to talk to your doctor about surgery for sacroiliitis. Surgery to treat sacroiliitis is rarely needed.

Surgery to fuse one or both SI joints is, which is called SI joint stabilization or SI joint fusion, prevents the joints from moving, and this may help relieve pain. Like several types of spine surgery, you may have the option to have the procedure performed traditionally (or open) or minimally invasively.

You can learn more about this type of surgery in Surgery for Sacroiliac Joint Dysfunction. If you are considering SI joint surgery, please also read this Sacroiliac Joint Fusion Surgery Update.

Tap into More Sacroiliac Joint Dysfunction Resources
Sacroiliitis and SI joint dysfunction can cause debilitating pain and loss of function. Fortunately, several treatments can help ease your pain. To learn more about your options, check out the Sacroiliac Joint Center. You can also visit the Patients' Guide to Sacroiliac Joint Problems to further explore the condition and read patient stories.

Updated on: 02/15/18
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