Treatment of Sacroiliitis

Sacroiliitis is a disorder that is far more complex than back pain and it is important to seek medical attention early if you develop the symptoms. The condition is complicated with a variety of causes; it may be secondary to an injury or pregnancy but this is not a disorder to gamble with. Delay may lead to joint degeneration or the pain may be a symptom of a larger, inflammatory arthritic condition known as ankylosing spondylitis. This is one of the many forms of inflammatory arthritis, the most common of which is rheumatoid arthritis. Complications of ankylosing spondylitis can be quite serious and include:

• Spine Deformities


• Difficulty Breathing


• Lung Infections


• Heart Problems. 

Symptoms OF Sacroiliitis

• Pain and stiffness in lower back, thighs, buttocks


• Pain becomes worse with walking, due to the motion of the hips.


• Psoriasis, an inflammatory skin condition, may occur with a type of arthritis and sacroiliitis.


• Pain radiating down leg, often mimicking sciatica


• Limp


• Decreased range of motion


• Elevated temperature


• Bloody diarrhea occurs with Reiter's Syndrome, which causes painful urination, joint pain, sacroiliac joint pain, and eye inflammation, and accompanies sacroiliitis.


• Eye inflammation in one or both eyes, a symptom of Reiter's Syndrome and evident with sacroiliitis. 
  

Diagnosis

• History and Physical


• When examined, pain localized around sacroiliac joints, can be detected.


• Laboratory studies, including blood cultures


• X-rays of sacroiliac joints


• MRI (Magnetic Resonance Imaging) scan of sacroiliac joints


• Culture of fluid from affected sacroiliac joint 

It is important that the doctor be informed if there is a history of IV Drug use and whether any antibiotics have been taken recently. Recent antibiotic use can delay the proper diagnosis and identification of the infectious organism if a blood culture is done.

Treatment

The underlying cause and symptoms are considered when implementing a treatment plan.

• NSAIDs (Non-Steroidal Anti-inflammatory Drugs) such as naproxyn and ibuprophen reduce inflammation and pain.


• Cortiosteroid Drugs, such as prednisone and medrol, reduce inflammation and slow down joint deterioration.


• DMARDs (Disease Modifying Anti-rheumatic Drugs), such as Azulfidine and methotrexate, help limit joint damage.


• Antibiotics, if an underlying infection is determined by a blood culture or culture of fluid from infected sacroiliac joints. Drug must be specific for that infectious organism.


• Rest to relieve strain on sacroiliac joints.


• Tumor necrosis factor inhibitor medications, such as Enbrel, Humira, Remicade, can block a cell protein that acts as an inflammatory agent. This helps reduce pain and stiffness. These medications are quite expensive and may not be prescribed unless other medications are not effective.


• Physical therapy will be started after the painful, acute phase is under control. Range of motion exercises and stretching exercises to improve muscle strength and joint flexibility.

         Decrease or eliminate smoking because nicotine decreases the blood flow to the affected areas and makes it more difficult for the body to fight the disease. 

These medications can effectively relieve the painful symptoms of sacroiliitis but they have many side-effects. They may interact with medications you are already taking so it is important that you understand all their side-effects and how to use them appropriately. Some of these drugs increase the risk of bleeding, the risk of a cardio-vascular event or damage to your kidneys, liver or gastrointestinal tract. Complete patient education is vital to the management of sacroiliitis and the effective relief of its symptoms.