Sacroiliitis: causes, symptoms and treatment

Sacroiliitis is inflammation of one or both sacroiliac joints, located in the area where the lower spine and pelvis connect. Sacroiliitis can cause pain in the buttocks or lower back, which can spread to one or both legs. Standing for a long time or climbing stairs can make the pain worse.

Sacroiliitis can be difficult to diagnose because it can be confused with other causes of low back pain. It has been linked to a group of diseases that cause inflammatory arthritis of the spine. Treatment may involve physical therapy and medication.

Sacroiliitis pain most often occurs in the buttocks and lower back. It can also affect the legs, groin, and even the feet. Sacroiliitis can be made worse by: Standing for a long time Carrying more weight on one leg than the other Climbing stairs Running Taking long steps

During the physical exam, the doctor may try to identify the cause of the pain by pressing on different parts of the hips and buttocks. He or she can move your legs into different positions to put light pressure on the sacroiliac joints.

A pelvic x-ray may reveal signs of injury to the sacroiliac joint. If ankylosing spondylitis is suspected, your doctor might recommend an MRI (a test that uses radio waves and a strong magnetic field to produce detailed cross-sectional images of bones and soft tissues).

Since low back pain can stem from a variety of causes, your doctor may suggest an injectable anesthetic to help with the diagnosis. For example, if such an injection is placed in the sacroiliac joint and it stops the pain, the problem is likely to be in that joint. However, anesthetic can leak into nearby structures, which can compromise the reliability of this test.

Treatment depends on the cause of your signs and symptoms, as well as the cause of sacroiliitis.

Depending on the cause of the pain, your doctor might recommend:

Analgesics. If over-the-counter pain relievers don’t provide enough relief, your doctor may prescribe stronger versions of these medications.

Muscle relaxants. Medications such as cyclobenzaprine (Amriz, Fexmid) can help reduce muscle spasms often associated with sacroiliitis.

Tumor necrosis factor inhibitors. Tumor necrosis factor inhibitors — such as etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) — often help relieve sacroiliitis associated with ankylosing spondylitis.

Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to keep your joints flexible and strengthening exercises to make your muscles more stable.

If other methods don’t relieve your pain, your doctor might suggest the following: Joint injections. Corticosteroids may be injected into the joint to reduce inflammation and pain. You may only get a few joint injections a year because steroids can weaken the bones and tendons in the joints. Radiofrequency denervation. Radiofrequency energy can damage or destroy nerve tissue that causes pain. Electrical stimulation. Implanting an electrical stimulator in the sacrum can help reduce pain caused by sacroiliitis. Joint Merger. Although surgery is rarely done to treat sacroiliitis, fusing two bones together with a metal item can sometimes relieve the pain of this condition.