Sacroiliitis

Overview

Sacroiliitis (say-kroe-il-e-I-tis) is a painful condition of swelling and irritation, called inflammation, that affects one or both sacroiliac joints. These joints sit where the lower spine and pelvis meet.

Sacroiliitis can cause pain and stiffness in the buttocks or lower back. The pain might go down one or both thighs. Standing or sitting for a long time or climbing stairs can make the pain worse.

Sacroiliitis can be hard to diagnose because it can be like other causes of low back pain. It's been linked to a group of diseases that cause inflammatory arthritis of the spine. Treatment might involve physical therapy and medicines.

Causes

Causes of sacroiliac joint issues include:

• Injury. A sudden hit to the sacroiliac joints, such as from a motor vehicle accident or a fall, can damage them.
• Arthritis. Wear-and-tear arthritis, also known as osteoarthritis, can happen in sacroiliac joints. So can a type of arthritis that affects the spine, called ankylosing spondylitis.
• Pregnancy. The sacroiliac joints loosen and stretch for childbirth. The added weight and changed way of walking during pregnancy can stress these joints.
• Not moving enough. A lack of exercise can lead to tight muscles and tension around the joint.
• Infection. Rarely, a sacroiliac joint can become infected. The risk is higher in people who have diabetes or who shoot street drugs with a needle.
• Surgery to fuse the spine. This can cause damage to the joint, ligaments and nerves around the joint.

Complications

Sacroiliitis can make it hard to do certain actions, such as bending, lifting, staying in one place and rising from being seated. The lasting pain of sacroiliitis can lead to depression and loss of sleep.

Treatment

Treatment depends on symptoms and the cause of the sacroiliitis. Doing exercises that stretch and build strength and taking nonsteroidal anti-inflammatory pain relievers you can get without a prescription are often the first treatments.

Medicines

Depending on the cause of the pain, these might include:

• Pain relievers. Nonsteroidal anti-inflammatory pain relievers you can get without a prescription include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). You also can try acetaminophen (Tylenol). If these don't give enough relief, a healthcare professional might prescribe a stronger pain reliever.

  Pain relievers you put on the skin over the sore area may give some relief. These may include lidocaine or menthol patches.

• Muscle relaxers. Medicines such as cyclobenzaprine (Amrix, Tonmya) might help ease the muscle spasms that often go along with sacroiliitis.
• Biologics. Biologic medicines treat many conditions in which the immune system attacks healthy tissues by mistake, called autoimmune conditions. Interleukin-17 (IL-17) inhibitors include secukinumab (Cosentyx) and ixekizumab (Taltz). Tumor necrosis factor (TNF) inhibitors include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) and golimumab (Simponi). Both IL-17 inhibitors and TNF inhibitors may relieve sacroiliitis.
• Disease-modifying antirheumatic drugs (DMARDs). DMARDs are medicines that lessen swelling and irritation, called inflammation, and pain. Some DMARDs target and block an enzyme called Janus kinase (JAK). JAK inhibitors include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Therapy

A healthcare professional, such as a physical therapist, can teach range-of-motion and stretching exercises. You do these exercises to ease pain and help the low back and hips move better. Exercises for strength help protect the joints and make posture better.

A physical therapist may suggest using a support, such as a pelvic belt, to help limit motion and ease pain.

Surgical and other procedures

If other methods don't relieve pain, a healthcare professional might suggest:

• Shots into the joint. Corticosteroids that go into the joint may ease swelling and pain. An image-guided shot into the joint may help if other treatments haven't worked. X-ray or ultrasound may help guide the shot to the right place. You can get only a few of these shots a year because the steroids can weaken nearby bones and tendons.
• Radiofrequency denervation. Radiofrequency energy can damage or destroy the nerve causing the pain.

• Platelet-rich plasma. This treatment involves injecting some of your own blood into the joint. The part of the blood used for the treatment has more platelets than usual. Platelets are cells in blood that help it clot and repair tissue damage.

  Some studies show that this treatment eases sacroiliitis pain. More study is needed.

• Joint fusion. Surgery is a rare treatment for sacroiliitis. It involves joining the two bones with metal hardware to ease sacroiliitis pain.

Preparing for an appointment

You might start by seeing your main healthcare professional, who may send you to a specialist in diseases that involve the bones and joints, known as a rheumatologist. You also might see an orthopedic surgeon.

What you can do

Take a family member or friend along, if possible. Someone who's with you can help you remember the information you get.

Make a list of:

• Your symptoms and when they began.
• Key information, including recent life changes and whether any first-degree relatives, such as a parent or a sibling, have had symptoms like yours.
• All medicines, vitamins and other supplements you take, including dosages.
• Questions to ask your healthcare professional.

For sacroiliitis, questions to ask include:

• What's likely causing my symptoms?
• What are other possible causes?
• What tests do I need?
• Is my condition likely to go away or to last?
• What's a good treatment for me?
• How can I manage this condition with my other health conditions?
• Are there restrictions I need to follow?
• Are there brochures or other printed materials I can have? What websites do you suggest?

Ask all the questions you have.

What to expect from your doctor

Your healthcare professional might ask you questions such as:

• Do you have your symptoms all the time or do they come and go?
• Where exactly is the pain? How bad is it?
• Does anything make the pain better? Does anything make it worse?