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Sacroiliitis

Definition :
Sacroiliitis is an inflammation of one or both of the sacroiliac joints, which connect your lower spine and pelvis.

The sacroiliac joints, also called SI joints, have a limited range of motion compared with other major joints in your body, such as your knee or elbow. With sacroiliitis, even the slightest movements of your spine can be extremely uncomfortable or even painful.

Sacroiliitis is difficult for doctors to diagnose, and it may be mistaken for other causes of low back pain, including sciatica, herniated disks and strained muscles. Sacroiliitis is often associated with a group of diseases called spondyloarthropathies, which cause inflammatory arthritis of the spine.

Treatment for sacroiliitis may involve a combination of rest, physical therapy and medications.

Causes:
Sacroiliitis is an inflammation of one or both of the sacroiliac joints, which connect your lower spine and pelvis.

The sacroiliac joints, also called SI joints, have a limited range of motion compared with other major joints in your body, such as your knee or elbow. With sacroiliitis, even the slightest movements of your spine can be extremely uncomfortable or even painful.

Sacroiliitis is difficult for doctors to diagnose, and it may be mistaken for other causes of low back pain, including sciatica, herniated disks and strained muscles. Sacroiliitis is often associated with a group of diseases called spondyloarthropathies, which cause inflammatory arthritis of the spine.

Treatment for sacroiliitis may involve a combination of rest, physical therapy and medications.

Risk Factor :
Because infection and inflammation can infect almost anyone at any age, it's difficult to say if sacroiliitis will affect you. However, the following factors may increase your likelihood of getting the condition :

  • A history of bone, joint or skin infections. Some people are more prone to infections, and an infection is one possible cause of sacroiliitis.
  • Injury or trauma to your spine, pelvis or buttocks. Torn ligaments or trauma may create inflammation or infection of the sacroiliac joints.
  • Urinary tract infection. This infection may spread from your urinary tract, which includes your kidneys, bladder and urethra, to your sacroiliac joints.
  • Pregnancy. The pelvic bone's expansion to prepare for childbirth may inflame the area around your sacroiliac joints.
  • Endocarditis. This infection of your heart's inner lining may spread to your sacroiliac joints.
Symptoms:
Many rheumatic diseases aren't limited to inflammation of the joints and extend to other organs of your body, such as your skin, blood vessels, eyes, heart, lungs, kidneys and nervous system. Signs and symptoms of sacroiliitis may include :
  • Pain and stiffness in your lower back, thighs or buttocks, especially in the morning or when sitting for a long period of time
  • Pain affecting your hips and shoulders
  • Pain that worsens with walking because the swinging motion of your hips strains your sacroiliac joints
  • Inflammation in one or both of your eyes (uveitis or iritis)
  • Psoriasis, an inflammatory skin condition
  • Bloody diarrhea
  • A low-grade fever that appears quickly


Diagnosis:
Screening and diagnosis of sacroiliitis is difficult.

First, thick muscle tissue surrounds the sacroiliac joints, so their location deep in the muscles of your buttocks makes these joints hard to examine. Second, the pain may be so severe that you lack the ability or willingness to move much during the screening process, making it harder for your doctor to pinpoint the pain. Finally, diagnosis is difficult because of the large number of possibilities that exist when determining the cause of low back pain.

With these factors in mind, your doctor may confirm a diagnosis based on :

  • Localized pain that seems to be on or around your sacroiliac joints, which a doctor can determine by pressing on your sacroiliac region while you move in certain ways to gently stress the sacroiliac joint
  • X-rays of your sacroiliac joints
  • Magnetic resonance imaging (MRI) scan of your sacroiliac joints
  • Cultures of fluid from the sacroiliac joint
  • Blood culture, if the cause appears to be an infection
Complications :
Delayed treatment of sacroiliitis — either because of an incorrect diagnosis or because you've put off going to your doctor — can cause serious harm to your sacroiliac joints. Sacroiliitis may be part of a larger inflammatory arthritis condition known as ankylosing spondylitis.

Ankylosing spondylitis is one of many forms of inflammatory arthritis, the most common of which is rheumatoid arthritis. Complications of ankylosing spondylitis can be very serious, including difficulty breathing, spine deformities, lung infections and heart problems.

Treatment:
Treatment depends on the signs and symptoms as well as the underlying cause. Medications to treat sacroiliitis may include :

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These pain-relieving drugs reduce swelling and inflammation. NSAIDs include indomethacin (Indocin), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Anaprox, others). Taking NSAIDs can lead to side effects, such as indigestion and stomach bleeding. Other potential side effects may include damage to your liver and kidneys, ringing in your ears (tinnitus), fluid retention and high blood pressure. Except for aspirin, NSAIDs may also increase your risk of cardiovascular events, such as heart attack or stroke.
  • Corticosteroids. These medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain and slow joint damage. Cortisone injections can be used for localized pain relief that lasts a period of months. In the short term, corticosteroids can make you feel dramatically better. But when used for many months, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
  • Disease-modifying antirheumatic drugs (DMARDs). These medications include sulfasalazine (Azulfidine) and methotrexate (Rheumatrex). Doctors prescribe DMARDs to limit joint damage. Taking these drugs at early stages in the development of a joint condition is especially important to slow the disease and save the joints and other tissues from permanent damage. Because many of these drugs act slowly — it may take weeks to months before you notice any benefit — DMARDs typically are used with an NSAID or a corticosteroid. While the NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD modifies the disease itself.
  • Tumor necrosis factor (TNF) inhibitors. These therapies, which include etanercept (Enbrel) and infliximab (Remicade), block a cell protein (cytokine) that acts as an inflammatory agent. Blocking the TNF cytokine may help reduce pain, stiffness and tender or swollen joints.

Physical therapy
Treatment may also involve physical therapy and rest to help manage pain and stiffness. Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to maintain joint flexibility, and strengthening exercises to give your muscles additional stability.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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