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Sacroiliitis: Causes, Symptoms & Treatment

Sacroiliitis is an inflammation of the sacroiliac joint, connecting the sacrum and the ilium of the pelvis. It causes lower back pain and may indicate inflammatory conditions.

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Things worth knowing about "Sacroiliitis"

Sacroiliitis is an inflammation of the sacroiliac joint, connecting the sacrum and the ilium of the pelvis. It causes lower back pain and may indicate inflammatory conditions.

What is Sacroiliitis?

Sacroiliitis refers to inflammation of the sacroiliac (SI) joint, which connects the sacrum (the triangular bone at the base of the spine) to the ilium of the pelvis. This joint plays a key role in transferring forces between the spine and the lower limbs. Inflammation in this area typically causes pain in the lower back and buttocks and may be one-sided or bilateral. Sacroiliitis is frequently an early manifestation of inflammatory rheumatic diseases and should be investigated thoroughly for an underlying cause.

Causes

Sacroiliitis can result from a variety of underlying conditions and factors:

Spondyloarthritis (including Ankylosing Spondylitis / Axial Spondyloarthritis): The most common cause of chronic sacroiliitis
Psoriatic Arthritis: Joint inflammation associated with psoriasis
Reactive Arthritis: Inflammatory joint response following infections
Inflammatory bowel disease such as Crohn's disease or ulcerative colitis
Bacterial infections of the joint (septic sacroiliitis), e.g., caused by Staphylococcus aureus
Pregnancy: Hormonal changes can loosen and inflame the sacroiliac joint
Trauma or overuse: Mechanical injury from accidents or intensive physical activity
Degenerative changes: Wear and tear in older age

Symptoms

The symptoms of sacroiliitis can vary depending on the underlying cause but commonly include:

Lower back and buttock pain, which may be one-sided or affect both sides
Pain radiating into the hip, thigh, or leg
Morning stiffness that improves with movement (characteristic of inflammatory causes)
Worsening of pain after prolonged sitting, standing, or climbing stairs
Fever and general malaise in cases of infectious sacroiliitis
Tenderness over the SI joint on palpation

Diagnosis

Diagnosing sacroiliitis involves a combination of clinical examination, laboratory tests, and imaging:

Physical examination: Specific provocation tests such as the FABER test and Menell test to assess the SI joints
Blood tests: Inflammatory markers (CRP, ESR) and HLA-B27 genetic marker testing (frequently positive in spondyloarthritis)
MRI (Magnetic Resonance Imaging): The gold standard for early detection of inflammatory changes before structural damage appears on X-ray
X-ray: Reveals later structural changes such as joint space narrowing or bony fusion
CT (Computed Tomography): Provides detailed imaging of bony changes

Treatment

Treatment is tailored to the underlying cause and severity of the condition:

Pharmacological Treatment

NSAIDs (Non-steroidal anti-inflammatory drugs) such as ibuprofen or diclofenac: First-line treatment for pain relief and inflammation reduction
Corticosteroids: Short-term oral use or direct injection into the SI joint for severe symptoms
DMARDs (disease-modifying antirheumatic drugs) such as sulfasalazine for inflammatory rheumatic causes
Biologics (e.g., TNF-alpha inhibitors such as adalimumab or etanercept): For severe, refractory spondyloarthritis
Antibiotics: For bacterial (septic) sacroiliitis

Non-pharmacological Treatment

Physiotherapy: Targeted exercises to mobilize and strengthen the back and pelvic muscles
Heat therapy: Helps relieve muscle tension and reduce pain in chronic cases
Cold therapy: Useful during acute inflammatory flares
Lifestyle modifications: Adjusting physical activity levels and implementing ergonomic measures

Surgical Treatment

In rare cases where conservative treatments fail to provide adequate relief, sacroiliac joint fusion (surgical stabilization) may be considered.

Prognosis

The prognosis depends strongly on the underlying cause. With early diagnosis and consistent treatment, inflammation can often be well controlled. In inflammatory rheumatic conditions such as Ankylosing Spondylitis, long-term therapy and regular monitoring are essential to prevent progressive spinal fusion and functional impairment.

References

Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379-1390.
Slobodin G, Rimar D. Sacroiliitis - the early bird catches the worm. Rheumatol Int. 2020;40(8):1189-1199.
Ward MM et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019;71(10):1599-1613.

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