Sacroiliitis

The sacroiliac (SI) joints are where your pelvis and lower spine connect. Imagine the area just above your tailbone (the sacrum) and the top part of your pelvis (the ilium) – that's where these joints are. They help support your upper body weight when you stand.

Sacroiliitis is a condition that causes pain in one or both of these SI joints. It's located where your lower spine meets your pelvis. This pain often shows up in your buttocks or lower back, and sometimes it travels down one or both legs. Activities like prolonged standing, sitting, or climbing stairs can make the pain worse.

Sometimes, sacroiliitis is hard to pinpoint because the pain can mimic other types of lower back pain. It's sometimes connected to conditions that cause inflammation in the spine. Treatment often involves physical therapy to improve movement and reduce pain, and possibly medications.

Sacroiliitis pain is typically felt in the buttocks and lower back. However, it can also spread to the legs, groin, and even the feet. Interestingly, the pain sometimes gets better when you move around.

Several activities and positions can worsen sacroiliitis pain:

• Extended periods of sitting or lying down: Staying still for a long time can put extra stress on the sacroiliac joints.
• Prolonged standing: Standing for extended periods can also strain these joints.
• Uneven weight distribution: Putting more weight on one leg than the other, as you might do when walking or standing, can irritate the affected joint.
• Stair climbing: Going up or down stairs can put a lot of pressure on the sacroiliac joints.
• Running: Running, especially if you're not used to it or have poor running form, can put a lot of force on your spine and hips, potentially exacerbating the pain.
• Taking large strides: Large strides, especially when walking or running, can put extra stress on the joints, possibly increasing discomfort.

Sacroiliac joint problems can have several causes.

Trauma: A sudden, forceful impact, like a car crash or a fall, can injure the sacroiliac joints, causing pain and inflammation. This type of injury is sometimes called a sprain or strain.

Degenerative Conditions: Just like other joints in the body, the sacroiliac joints can develop wear and tear over time. This is known as osteoarthritis. Another type of arthritis, called ankylosing spondylitis, which affects the spine, can also impact the sacroiliac joints. This type of arthritis can cause inflammation and stiffness in the joints.

Pregnancy: A woman's body prepares for childbirth by loosening the ligaments around the sacroiliac joints. This allows for the widening of the pelvis, which is crucial for giving birth. However, this loosening can also put extra stress on the joints, leading to pain, especially as the weight of the growing baby increases. The change in gait (walking pattern) during pregnancy also puts extra strain on these joints.

Infection: In rare cases, bacteria or other organisms can infect the sacroiliac joint. This infection can cause severe pain, swelling, and tenderness. It's important to seek medical attention if you suspect an infection.

Sacroiliac joint swelling can be more likely in some people.

Conditions like ankylosing spondylitis and psoriatic arthritis, which are types of arthritis causing inflammation, can make sacroiliac joint swelling (sacroiliitis) more likely. Similar inflammation can occur in people with inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

Pregnancy and childbirth can also put extra stress on the sacroiliac joints, potentially leading to pain and swelling. The changes in the body during pregnancy and the physical demands of labor can stretch and strain these joints, increasing the risk of discomfort.

Doctors check for sacroiliac joint pain by gently pressing on the hips and buttocks. They might also move your legs in different positions to see how it affects the pain. This helps pinpoint if the problem is in the sacroiliac joint (where the pelvis connects to the spine).

To get a clearer picture, doctors might use imaging tests. An X-ray of your pelvis can reveal any damage to the sacroiliac joint, like signs of wear and tear or fractures. A more detailed picture, an MRI scan, can show if the damage is related to a condition like ankylosing spondylitis, a type of arthritis that affects the spine.

Sometimes, a doctor might inject a numbing medicine directly into the sacroiliac joint. If this reduces or eliminates the pain, it strongly suggests the problem is indeed within the sacroiliac joint itself.

Other imaging tests that might be used include CT scans, MRIs, ultrasounds, and X-rays. These different tests provide various levels of detail to help pinpoint the cause of the pain and the best course of treatment.

Treating Sacroiliitis Pain: A Guide

Sacroiliitis is a condition causing pain and inflammation in the sacroiliac joints, located where the spine meets the pelvis. Doctors can sometimes use a numbing medicine in the joint to help pinpoint the source of the problem. Treatment for sacroiliitis depends on the cause and the severity of symptoms.

Initial Treatments:

Often, the first steps to managing sacroiliitis pain involve simple, non-prescription strategies:

• Pain relievers: Over-the-counter pain medications like ibuprofen (Advil, Motrin) and naproxen (Aleve) can help reduce inflammation and pain. If these aren't enough, a doctor might prescribe stronger options.
• Muscle relaxants: Muscle spasms are common with sacroiliitis. Medications like cyclobenzaprine (Amrix) can help relax the muscles and ease pain.

More Advanced Treatments (for severe or persistent pain):

If initial treatments don't work, a doctor might suggest other options, often categorized by how they address the underlying cause of inflammation:

• Biologics: These medications target specific proteins in the body that contribute to inflammation. Examples include:
  • Interleukin-17 (IL-17) inhibitors: These medications, like secukinumab (Cosentyx) and ixekizumab (Taltz), reduce inflammation.
  • Tumor Necrosis Factor (TNF) inhibitors: These medications, including etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and golimumab (Simponi), also help reduce inflammation. These medications are often used for other conditions too.
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs): DMARDs are medications used to reduce inflammation and pain. Some DMARDs block an enzyme called Janus kinase (JAK). Examples include tofacitinib (Xeljanz) and upadacitinib (Rinvoq). These are used in situations where other medicines aren't working.

Lifestyle and Physical Therapies:

Alongside medication, a physical therapist can teach exercises to improve flexibility and strengthen the muscles supporting the lower back and hips. These exercises can help reduce pain and improve posture.

Injections and Other Procedures (as a last resort):

If other treatments fail, a doctor might suggest:

• Joint injections: Corticosteroids can be injected directly into the joint to reduce swelling and pain. However, these injections should be used sparingly as they can weaken surrounding bone and tissue. Only a few injections per year are usually recommended.
• Radiofrequency denervation: This procedure uses radio waves to disrupt the nerves sending pain signals.
• Electrical stimulation: An electrical stimulator can be implanted in the lower spine to help reduce pain.
• Joint fusion: In rare cases, surgery to fuse the sacroiliac joints together using metal hardware can be an option. This is typically only considered if other methods have failed.

It's important to remember that treatment plans are tailored to individual needs and should be discussed with a healthcare professional.