Generality
Sacroiliitis is inflammation of the sacroiliac joints (or sacroiliac joints).
The causes of sacroiliitis include: injuries of traumatic origin, arthritis, pregnancy, various types of infections, etc.
The typical symptom of sacroiliitis is back pain, pain that can sometimes radiate to the legs and feet.
For a correct diagnosis of sacroiliitis, physical examination, medical history, X-rays and, in some cases, even nuclear magnetic resonance are essential.
The treatment of sacroiliitis depends on the triggering causes and the intensity of the symptoms.
What is sacroiliitis?
Sacroiliitis is inflammation of one or both sacroiliac joints (or sacroiliac joints).
The sacrum iliac joint is that equal joint element, located at the base of the vertebral column, which connects the sacrum to the right iliac bone and to the left iliac bone. Its main function is to support the weight of the upper body, when an individual stands up, walks, runs etc.
Thanks to the figure below, readers can become aware of the precise location of the sacroiliac joints and which are the sacrum and the two iliac bones.
Figure: the sacroiliac joints.
Figure: sacrum (in red). It is an unequal bone, asymmetrical and triangular in shape, which resides in the lower part of the spine, exactly between the lumbar spine and the coccyx.
In fact, it is the result of the fusion of the 5 sacral vertebrae of the spine, a fusion that occurs between 18 and 30 years of life.
The sacrum takes part in 4 joints: the two joints with the iliac bones (sacro iliac joint), the joint with the last lumbar vertebra and the joint with the coccygeal vertebra.
The sacrum, the two iliac bones, and the coccyx make up the skeletal region known as the pelvis.
Figure: Iliac bone, also known as coxal bone or hip bone. It is an even and symmetrical bone, which resides alongside the sacrum.
It derives from the fusion of three bones: ilium, ischium and pubis. The merger process generally ends at the age of 14/15.
Each iliac bone takes part in 3 joints: the joint with the other iliac bone (in the so-called pubic symphysis), the joint with the sacrum (sacro iliac joint) and the joint with the femur (hip joint) .
Causes
Possible causes or predisposing factors of sacroiliitis:
- Injuries of traumatic origin of one or both sacroiliac joints. In most cases, these types of accidents occur as a result of car accidents or after accidental falls of a certain significance;
- Arthritis. In medicine, the term arthritis refers to the inflammation of one or more joints in the human body. There are several forms of arthritis; among the forms of arthritis that can cause sacroiliitis, ankylosing spondylitis, gout, psoriatic arthritis, systemic lupus erythematosus, enteropathic arthritis, osteoarthritis, reactive arthritis and rheumatoid arthritis deserve special mention;
- The state of pregnancy. During pregnancy, the pelvis tends to widen to accommodate the developing fetus. The enlargement of the pelvis concerns, for obvious reasons, the sacroiliac joints and could, for the latter, be a source of stress;
- Infection of one of the two sacroiliac joints;
- Infection of one of the bones participating in the sacroiliac joints. The precise medical term, which identifies a bone infection, is osteomyelitis;
- Certain inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis;
- Urinary tract infections;
- Infections of the inner lining of the heart and heart valves. In medicine, an "infection affecting the aforementioned lining takes the generic name of endocarditis;
- The abuse of some drugs.
Symptoms and Complications
The characteristic symptom of sacroiliitis is pain located in the buttocks and lower back.
Sometimes, the painful sensation also affects the legs, groin region and even the feet (very rare cases).
Causes of sacroiliitis from bilateral and symmetrical pain
- Ankylosing spondylitis
- Enteropathic arthritis
- Crohn's disease
- Ulcerative colitis
Causes of sacroiliitis from bilateral and asymmetrical pain
- Osteoarthritis
- Reactive arthritis
- Rheumatoid arthritis
- Psoriatic arthritis
- Gout
Causes of unilateral pain sacroiliitis
- Infections
WHAT AGGRESSES THE PAIN
Certain gestures and behaviors can aggravate the pain resulting from a condition of sacroiliitis, including:
- Stand for many hours consecutively;
- Taking the stairs;
- Running, jumping etc;
- Assume incorrect postures, which particularly affect one of the two legs;
- Walking with long strides;
- Rolling over in bed;
- Sitting for a long time.
COMPLICATIONS
In the absence of adequate and timely treatment, sacroiliitis can cause chronic pain.
Generally, medical conditions that cause chronic pain lead to depression and / or insomnia. In this sense, sacroiliitis makes no exceptions.
Diagnosis
Usually, for a correct diagnosis of sacroiliitis, the following are essential: a physical examination, anamnesis, an x-ray of the spine and, sometimes, also an MRI (always of the spine).
OBJECTIVE EXAMINATION AND HISTORY
The physical examination is the set of diagnostic maneuvers, carried out by the doctor, to verify the presence or absence, in the patient, of the signs indicative of an abnormal condition.
For example, in the case of suspected sacroiliitis, one of the classic diagnostic maneuvers is to test the movements of the legs, in order to evaluate which of these are painful or not.
The anamnesis, on the other hand, is the collection and critical study of the symptoms and facts of medical interest, reported by the patient or his family (N.B: family members are involved, above all, when the patient is small).
In case of suspected sacroiliitis, the history can provide a wide range of information, regarding the possible factors that induced the inflammatory process in the sacroiliac joint.
RADIOGRAPHY AND MAGNETIC RESONANCE OF THE COLUMN
Radiography (or X-rays) and nuclear magnetic resonance imaging of the spine are two diagnostic imaging tests.
Both are excellent tests to assess whether and to what extent the sacroiliac joint or joints are damaged.
The nuclear magnetic resonance is particularly suitable for the detection of a sacroiliitis due to ankylosing spondylitis.
DIFFICULTY IN DIAGNOSIS
Sacroiliitis is a rather difficult condition to diagnose, as there are many medical conditions with similar symptoms (sciatica, etc.).
Treatment
Treatment of sacroiliitis depends on at least two factors: the intensity of the symptoms and the triggering factors.
Generally, doctors prefer conservative therapy, reserving the right to resort to surgery (surgical therapy) and other rather invasive remedies only if the conservative remedies have not provided any results (or the results provided are unsatisfactory and the patient continues to experience pain , swelling, etc.).
CONSERVATIVE THERAPY
Among the possible conservative treatments, for the treatment of a sacroiliitis and the pain deriving from it, include:
- The rest. Keeping the painful sacroiliac joint (s) at rest favors the reduction of the inflammatory state;
- The application of ice on the painful back area at least 4-5 times a day. The ice packs have an incredible anti-inflammatory power. Each pack must have a minimum duration of 15 minutes and must not exceed 20 minutes;
- The suspension of all those activities that tend to worsen back pain;
- Adopting a position during sleep that relieves lower back pain. Your doctor recommends avoiding any position that may worsen the painful sensation;
- The administration of non-steroidal anti-inflammatory drugs (NSAIDs). Ibuprofen is one of the most suitable NSAIDs;
- The administration of muscle relaxants. Cyclobenzaprine is one of the most prescribed muscle relaxants in case of sacroiliitis;
- Administration of TNF alpha inhibitor drugs (etanercept, adalimumab and infliximab). They are particularly useful when the cause of sacroiliitis is ankylosing spondylitis;
- The administration of corticosteroids through direct injections into the painful joint. Corticosteroids are powerful anti-inflammatory drugs, the prolonged use of which could have several side effects. For this reason, doctors prescribe them only when NSAIDs have been ineffective and the pain is still present;
- Physiotherapy. Physiotherapy for sacroiliitis includes strengthening exercises of the back muscles and exercises of stretching of the sacro iliac joint.
SURGERY THERAPY AND OTHER TREATMENTS
Surgical treatment for sacroiliitis consists of the so-called sacro iliac arthrodesis surgery.
By arthrodesis or joint fusion or surgical ankylosis, doctors mean that "surgery which involves the fusion of the bony elements constituting a" mobile or semi-mobile joint of the human body and which has the purpose of relieving severe joint pain.
In the specific case of sacro iliac arthrodesis, this is the procedure aimed at fusion of the sacrum to one or both iliac bones.
Arthrodesis interventions are rather delicate procedures, not without risks and, clearly, quite invasive. For this reason, doctors only resort to it in extreme cases.
Although they are not strictly surgical, other treatments with a certain invasiveness and considered only following the failure of conservative therapy are:
- The so-called denervation by radiofrequency: radiofrequency is a particular form of energy, capable of destroying nervous tissue. Through radiofrequency denervation, doctors destroy the nerve tissue that surrounds the sacroiliac joint and which is responsible for the painful sensation.
- Electrical stimulation, operated through a special instrument. Implanted close to the sacrum, this instrument - which is an electrical stimulator - has the effect of relieving the painful sensation.
Prognosis
The prognosis in case of sacroiliitis depends mainly on the triggering factors: the more clinically relevant a cause is, the greater the difficulties in treating inflammation of the sacroiliac joints.
Typically, early diagnosis of sacroiliitis makes conservative treatments more effective.
