Sacroiliitis - An Overview

What Is Sacroiliitis?

Sacroiliitis is an inflammation of either one or both of the sacroiliac joints, and it is a common source of pain in the buttocks or the lower back. Inflammation of the sacroiliac joint can be brought on by several different factors, including osteoarthritis, pregnancy, spondyloarthropathies, and trauma.

What Are the Types of Sacroiliitis?

Various conditions can cause Sacroiliitis. As there are many influencers of sacroiliitis, it is differentiated into various types, such as

• Inflammatory.

• Degenerative.

• Pyogenic.

What Are the Causes of Sacroiliitis?

Sacroiliitis is caused by a variety of factors, one of which is a genetic predisposition to develop the disorder.

• Ankylosing Spondylitis- It is a degenerative kind of inflammatory arthritis that first manifests in the hips and then works its way down the spine. Sacroiliitis is one of the earliest symptoms of the illness. Any type of spondyloarthropathy, such as ankylosing spondylitis, arthritis linked with psoriasis, or any other form of rheumatologic disease, such as lupus.

• Degenerative Arthritis- Is also known as osteoarthritis of the spine, is a condition that leads to the degeneration of the sacroiliac joints, which then causes discomfort and inflammation in those joints.

• Trauma- Accidents or falls can cause sacroiliac joint damage and inflammation, which can eventually develop into degenerative sacroiliitis. This condition affects the lower back, hips, or buttocks and can be caused by a rapid traumatic injury.

• Pregnancy- Pregnancy and childbirth, specifically the process of giving birth, causes the pelvis to expand and stretch the sacroiliac joints. This could lead to sacroiliitis if the joints are overworked and stressed.

• Infection- When an infection of the sacroiliac joint develops, the joint swells, gets inflamed, and is more vulnerable to injury.

• Osteomyelitis- Inflammation of the bone brought on by an infection, which can spread to the bone marrow as well as the tissues that are close to the bone. The infected bone may experience excruciating pain if osteomyelitis is present.

• Endocarditis- A disorder in which the tissues that line the inside of the heart and the heart valves become swollen and reddened with inflammation.

• Crohn's Disease- A disorder characterized by chronic inflammation of the gastrointestinal tract. Typically, Crohn's disease affects the small intestine and colon. There are fever, diarrhea, stomach cramps, vomiting, and weight loss among the symptoms.

• Gout- Gout is an inflammatory arthritis-like condition caused by an excess of uric acid in the blood.

• Physical Action- It is possible for it to worsen preexisting sacroiliitis, especially when sitting or standing for long periods.

What Is the Diagnosis of Sacroiliitis?

The diagnosis of sacroiliitis depends on the following tests:

• Physical Examination- The mobility test along the spine would be inspected for proper alignment and rotation, and a variety of other physical movement tests would also be done. This would be part of the examination. Provocative tests of this kind are employed to recreate the discomfort that patients feel.

• Fortin Finger Sign- If this test is positive, there is a generation of pain following the application of deep palpation with the four fingers of the affected hand posteriorly at the patient's SI joints.

• FABER Test- If this test is positive, there is a recurrence of the pain experienced after flexing the hip while simultaneously abducting the leg and externally rotating the hip.

• Sacral Distraction Test- If this test is positive, there is a recurrence of pain following the pressure being placed on the anterior superior iliac spine.

• Iliac Compression Test- If this test is positive, there is a recurrence of pain following the application of pressure in an inferior direction to the superior portion of the iliac crest

• Thigh-Trust Test- Acute pain is caused by extending the hip and exerting a force that shears posteriorly on the SI joint.

• Gaenslen Test- It was possible to reproduce the patient's agony by first instructing them to extend the hip on the unaffected side of their body and then by having them dangle the affected leg off the examining table. The pressure is then transferred to the sacroiliac (SI) joint as a result of the pressure being applied downward on the leg and extended further along the hip.

Blood Test

Inflammation is looked for using blood tests to determine the severity of the condition. Complete blood count, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, human leukocyte antigen, and rheumatoid factor are the blood tests that are performed on patients who have an inflammatory disorder.

Imaging Test

Imaging tests such as X-rays, CT scans, MRIs, and nuclear medicine can illustrate the anomalies in the soft tissue that is near the spine.

• Plain Radiograph- Even though it has low sensitivity and specificity in the early stages of the disease, routine radiography continues to be the primary imaging technique. Evaluation and comparison of both sides of the sacroiliac joints, focusing specifically on the sacroiliac joints. The radiographic findings include sclerosis of the endplates, particularly on the iliac side, uneven joint end plates, and broadening of the joint plates.

• CT Scans- Computed tomography provides better sensitivity, precision, and informational detail than conventional radiography.

• Nuclear Medicine- A bone scan shows an increased level of radioisotope activity in the joints, which helps to pinpoint the exact location of the discomfort.

• MRI- Magnetic resonance imaging (MRI) can reveal an early inflammatory change of joints even when other imaging is negative, and it can rule out other potential causes, including disc prolapse, that have symptoms that are similar to those of sacroiliitis.

What Are the Treatment Methods for Sacroiliitis?

There are numerous therapeutic options for sacroiliitis management. The treatment consists of medication, physical activity, and surgical procedures.

Medications:

The following medication help in treating the condition:

• Pain Reliever- Over-the-counter OTC pain medication could be able to provide some relief from the discomfort.
• Muscle Relaxant- Sacroiliitis is a painful condition that can produce painful muscle spasms. A muscle stress reducer may help alleviate the symptoms of the condition.
• TNF Inhibitor- Since sacroiliitis is often connected with ankylosing spondylitis, this drug may be able to assist in providing relief from this condition. Both physical activity and the function of the joints may benefit greatly from the TNF inhibitor.

Home Remedies:

In addition to the medication that was recommended, the following at-home treatments and physical activity can help alleviate the symptoms of the illness.

• Rest- Sacroiliitis is an inflammatory condition that can be helped by avoiding motions that make the condition worse.
• Ice and Heat Therapy- Sacroiliitis pain can be alleviated by alternating the use of ice and heat packs on the affected part of the body.

Physical Therapy:

Since it assists in stabilizing and strengthening the lumbopelvic muscle, physical therapy can be of use in the management of hypermobility. The discomfort may be brought on by immobility; however, physical therapy can assist in increasing the mobility of the SI joint, which should help alleviate the pain. Based on the patient's diagnosis, the following treatments may be administered.

• SI Belt - During the early stages of a pelvic belt or girdle when engaging in physical activity and activities of daily living. Compression is offered by these SI belts, which in turn helps hypermobile patients experience less SI movement. It is recommended that the belt be worn so that it is positioned anteriorly below the superior anterior iliac spines and posteriorly across the sacral base. If your disease becomes chronic, you can use this belt to help manage the symptoms.
• Flexion Exercise- When acute symptoms are under control, the patient can begin flexibility and stabilization exercises. Stretching activities are crucial for maintaining SI and low back flexibility. The purpose of these exercises is to stretch the paraspinal muscles, gluteus muscles, and SI joints via side bends, knee-chest pulls, and pelvic rockers. After hyperacute symptoms have gone, this type of activity may be performed.
• Stabilization Exercise- Patients who have issues with their sacroiliac joints can benefit from exercises that are geared specifically towards pelvic stabilization, as well as from postural instruction and training for the muscles of the trunk and lower extremities.

Surgery:

Patients who are dealing with serious conditions are often advised to go through with surgical procedures such as:

• Electrical Stimulation- The implantation of an electrical stimulator into the sacrum, which may assist in alleviating the discomfort, is performed.

• Joint Injection- The inflammation and pain may be alleviated with the injection of corticosteroids into the sacroiliac joint. It is possible to provide steroid injections for diagnostic as well as therapeutic purposes. If the disease does not improve despite receiving additional corticosteroid injections, the treatment should be repeated. After that, you should get started on some strengthening exercises, such as sit-ups and weighted side bends. The overall training of the back, as well as a gradual rise to low-impact activities such as walking and swimming. Injecting multiple times in a short period can result in further complications.

• Radiofrequency Denervation- This method of treatment is more targeted towards the exact area that is suspected of being the source of sacroiliac discomfort.

• Joint Fusion- Even though surgical procedures are rarely employed to treat sacroiliitis, sacroiliitis pain can be alleviated by fusing two bones using a metal plate or another device designed for bone fusion.

Conclusion:

Sacroiliitis is an inflammatory illness that can affect either one or both of the sacroiliac joints in the body. These joints are located between the sacrum, which is a bony structure located at the base of the spine, and the two bones that are at the top of the hip joint.

A secondary arthritic illness such as ankylosing spondylitis can bring on symptoms of sacroiliitis. Sacroiliitis is a condition that can be caused by pregnancy, trauma, or infection. The treatment would focus on the long-term management of the symptoms, such as by the use of medication, physical therapy, and in the most severe cases, surgery.