Sacroiliitis: The sacroiliac joints (SI joints) connect the spine to the pelvis and lower skeleton. These joints provide minimal movement; approximately two to four millimeters with weight bearing activity, unlike that of the hip or knee. The SI joint's main function is to provide shock absorption for the spine through a gliding-type motion. Sacroiliitis (inflammation of the SI joint) is commonly caused by degenerative arthritis, traumatic injury, motor vehicle accident, or blow to the buttock or pelvic region. Women are at risk for developing sacroiliitis from childbirth, as the female pelvis must stretch enough to allow birth. The ligaments around the joint, which connect one bone to another, may become inflamed or torn. Tearing of these ligaments can lead to too much motion in the joint, causing degenerative changes and chronic pain.
Symptoms: In most cases of sacroiliitis, there is a diffuse pattern of back and pelvic pain that mimic each other. Patients with SI inflammation will generally complain of low back, buttock, and thigh pain. This pain typically becomes worse when sitting for any prolonged period of time.
Sacroiliitis is commonly confused with sciatica. 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.
Causes: A wide range of factors may cause sacroiliitis:
- Heavy lifting, especially if you lift incorrectly or your muscles aren't prepared for the activity.
- A traumatic injury or sudden impact, such as a motor vehicle accident or a fall, affecting your spine, lower back, pelvis or buttocks.
- Spondyloarthropathies, which include ankylosing spondylitis, arthritis associated with psoriasis and others.
- Degenerative arthritis, also called osteoarthritis of the spine, causing degeneration of the sacroiliac joints, which can cause mild inflammation and pain.
- Pregnancy, because the pelvis must stretch to accommodate childbirth. Infection of the sacroiliac joint, sometimes caused by bacteria in food (brucellosis).
Treatment: In most cases rest, anti-inflammatory medication, and physical therapy alleviate symptomology. Physical therapy should focus on mobilization (exercise and manipulation by the therapist), and stabilization (muscle strengthening).
For pain relief, fluoroscopic guided injections into the joint may be warranted. The SI joint is located deep in the buttock region and is covered by thick muscle. The fluoroscope uses X-rays to help visualize the SI joint. This visualization allows the physician to see on screen the exact placement of the needle into the joint. Cortisone is typically injected into the joint to calm the inflammation and reduce pain.
Procedures: Spinal Injections: Spinal injections are used to diagnose and treat spinal conditions. With most spinal injections, a local anesthetic (numbing medication) is injected into a specific area of the spine. The anesthetic is fast-acting, but the effects wear off within about two hours. A strong anti-inflammatory steroid medication, such as cortisone, is usually injected with the anesthetic to reduce inflammation in the affected area. Cortisone is long lasting and can be slow releasing in order to give the best possible benefit of pain relief. Cortisone may take several days to start working, but the effects may last for months.
Several of the injections given at our office under fluoroscopic guidance include:
- Epidural Steroid Injections - Good for reducing radicular pain caused by nerve root irritation from herniated discs and spinal stenosis. The patient may require a series of several epidural injections over a period of a few weeks.
- Transforaminal Injections - Selective injection around a specific nerve root and into the spinal canal. This is more effective for nerve compression with sciatica.
- Facet Joint Injections - Used to localize and relieve low back and neck pain caused by arthritic facet joints.
- Sacroiliac Joint Injections - Used for pain from an inflamed sacroiliac joint.
- 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.
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.
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