Inflammation of sacroiliac joint

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Sacroiliitis is inflammation of the sacroiliac joint. This condition can be divided into infectious and non-infectious categories.

A patient with sacroiliitis due to infection will usually present with sudden onset of fever, pain and decreased range of motion in the low back.

Non-infectious sacroiliitis patients may or may not present with a fever. Patients can be ill (especially with infectious sacroiliitis). There is often a limp as well as pain and decreased range of motion. The symptoms, unfortunately, are generally vague. All patients with sacroiliitis will have sacroiliac joint pain, but this symptom can be missed.

The sacroiliac joint is located between the sacrum (tailbone) and the pelvis. It is surrounded by a large amount of ligamentous and fibrous tissue for stability. Conditions that can predispose patients to sacroiliitis include trauma, pregnancy, infections of the skin, osteomyelitis, urinary tract infection, endocarditis and drug addiction.

On physical examination, sacroiliac joint pain can be mistaken for septic hip, psoas abscess, malignancy, sciatica, herniated disc, pyelonephritis, or appendicitis.

A clinical, physical and laboratory evaluation is critical for an accurate and early diagnosis of sacroiliitis. It is important to localize the pain and assess for decreased motion. In most cases a blood culture can help make the diagnosis. MRI is helpful for diagnosis. An open biopsy and culture may be required to establish an accurate diagnosis and to identify the correct infectious agent.

Infectious sacroiliitis is treated with antibiotics and physical therapy.

The major non-infectious cause of sacroiliitis is ankylosing spondylitis. This is an autoimmune form of arthritis that preferentially attacks the sacroiliac joints, the spine, and the tendon insertions. Typically, a patient will be a young adult with morning stiffness in the low back and possibly the neck. Roughly, 90 per cent of patients with ankylosing spondylitis will be positive for the HLA-B27 antigen, specific genetic marker that can be obtained through blood testing. Ankylosing spondylitis is treated with a combination of anti-inflammatory drugs, disease modifying drugs such as methotrexate, and biologic therapy.

Other forms of spondyloarthropathy such as psoriatic arthritis and Reiter's disease as well as the arthritis of inflammatory bowel disease can also present with sacroiliitis.

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