Sacroiliac joint sacroiliitis: overview and overview of key treatment options

Brucellosis sacroiliitis
Brucellosis is characterized by the transient nature of tissue damage, which indicates the possible appearance of volatile arthralgias. In a number of clinical cases, persistent, long-term and, at the same time, difficult to stop inflammatory processes, expressed as synovitis or arthritis, can be observed.

Tandem with brucellosis can have different forms. Patients with this type of diagnosis complain of pain concentrated in the joint area, which can significantly intensify when performing various types of movements.

A conservative approach is required, involving a combination of specific therapy with the use of a complex of antibiotics, vaccination and the prescription of a number of medications.

Aseptic sacroiliitis

This is quite common for rheumatic diseases, in particular psoriatic arthritis.

X-ray examination makes it possible to make a diagnosis in the first stages of progression, which guarantees successful prognosis for recovery.

The primary stages involve a moderate widening of the joint gap, with unclear contours of the articulation.

The second stage involves a pronounced symptomatic picture, accompanied by a narrowing of the joint space and the formation of single erosions.

The third and fourth stages involve partial and complete ankylosis, respectively.

Symptoms of sacroiliitis of the presented type are mild. The pain can be of slight or moderate intensity, radiating to the thigh, increasing during a state of rest, and decreasing only with increased physical activity.

Diagnostic testing may require additional specific methods, which include laboratory testing.

Non-infectious sacroiliitis

Lesions of the sacroiliac joint of non-infectious origin do not belong to the concept of “sacroiliitis”, however, medical practice allows such a diagnosis.

Changes of this type may have a number of preconditions, the exact list of which is not easy to determine. Most likely, the pathologies are caused by previous injuries or systematic overload.

Among the complaints, spontaneous painful attacks are noted, localized in the sacral area. When performing movements, an increase in discomfort may be observed.

The main direction of treatment is the elimination of inflammation and pain. Physiotherapeutic procedures, taking a complex of medications and other solutions that can speed up recovery can be used as therapeutic methods.

Features of the course of pathological processes in children

At an early age, misdiagnosis often occurs with reference to an infectious lesion or acute appendicitis.

Children may experience symptoms of sacroiliitis such as:

• disruption of the gastrointestinal tract;
• Quite severe back pain radiating to the joints of the lower limb;
• spasms of the spinal muscle frame;
• moderate increase in body temperature.

In addition, it is worth paying special attention to the manifestation of symptoms characteristic of intoxication of the body, suggesting:

• chills;
• increased sweating;
• loss of appetite;
• headaches and disturbances in the functioning of the vestibular apparatus;
• slowing down of mental activity.

Endoprosthetics - a modern alternative to surgery

At the second and even third stage of arthrosis, progressive doctors recommend their patients intra-articular injection of a synovial fluid substitute, for example the drug Noltrex. The procedure is carried out in a dressing room, under local anesthesia, for 20-30 minutes. The full course involves several administrations at weekly intervals.

After a short period of time, the person forgets about the pain, mobility is restored, and the result lasts for 1-2 years. Endoprosthetics of synovial fluid is a relatively new treatment for arthrosis, however, due to its long-term effect and the absence of side effects, it is increasingly preferred instead of drugs based on hyaluronic acid.

Treatment with Noltrex is focused on long-term effects rather than temporary relief of symptoms.

The second degree of arthrosis is a certain intermediate stage. The period when it is not too late to start treatment, recover and return to a healthy lifestyle without pain and restrictions. The main thing is not to miss the first signs and take action in time, since otherwise the consequences for the joints can be unpredictable.

Diagnosis of sacroiliitis

The entire diagnostic technique of the disease in question lies in the study of clinical manifestations identified during the examination of the patient. A clarifying addition can be the results of additional research methods, the most important of which is considered to be x-ray.

The following diagnostic criteria are determined:

• intensity and nature of manifestation of existing symptoms;
• waking up at night due to discomfort;
• presence/absence of pain in the thoracic spine;
• study of existing inflammation;
• patient's medical history, taking into account various factors.

The main clinical signs remain:

• degree of limitation of mobility in the affected area;
• changes, violations of posture and the intensity of their manifestation.

Symptoms

Symptoms and signs of the disease at the initial stages of the disease are rather weakly expressed; arthrosis of the SIJ is accompanied by pain and limited motor ability.

Other symptoms:

• restrictions on physical activity;
• problems with urination;
• decreased libido;
• dysfunction of the hip joints;
• limitation of range of motion;
• worsening gait;
• tone in the sacrum.

At the initial stage of the disease, the symptoms are quite mild.
The chronic form is accompanied by constant pulling sensations and discomfort in the spinal area. The intensity of the pain syndrome increases during walking, lifting weights, and prolonged sitting. The pain intensifies when bending or turning the body.

Degrees of sacroiliitis

The degree of pathology is determined taking into account the collected medical history, as well as the results of an x-ray examination, which make it possible to determine not only the focus, but also the intensity of the spread of inflammation.

Let's consider the main indicators characteristic of each degree.

1st degree of sacroiliitis

Symptoms are mild. It is impossible to track any changes in the image.

2nd degree sacroiliitis

The outlines of the joint are extremely indistinct, one might even say blurry.

There is significant compaction of bone tissue and numerous erosions.

3rd degree of sacroiliitis

The narrowing of the joint space noticeably increases, the signs of ankylosis intensify (loss of mobility).

With the purulent type of lesions, bone tissue loses density, creating the preconditions for the development of osteoporosis.

4th degree of sacroiliitis

The joint gap completely disappears, and the final fusion of bone tissue occurs, accompanied by destruction of their structure.

The outlines of the joint become extremely uneven.

Causes of the disease

The sacroiliac joint (SIJ) is a pair. It is formed on both sides of the spine in the monolithic sacral region. The fusion sites are covered with hyaline cartilage. Rigid ligaments are formed around the SIJ. A small amount of synovial fluid is formed inside the joint capsule. The function of the CPS is to ensure:

• depreciation of the torso during movement;
• measured distribution of the load on the pelvis and legs with an upright body position and walking;
• stabilizing the body while sitting.

According to multiple medical studies, arthrosis of the sacroiliac joints in most cases develops against the background of an inflammatory process.

With age, the likelihood of arthrosis of the sacroiliac joints increases, as deformation of the corresponding part of the musculoskeletal system occurs to one degree or another. Predisposing factors have been identified that significantly contribute to the occurrence of degenerative and dystrophic changes:

• injuries of the lumbosacral spine, hips;
• repeated pregnancies, childbirth, birth of a large child;
• congenital anomalies of bone development;
• overweight;
• infections affecting bone tissue;
• a metabolic disorder that results in calcium deficiency in the body;
• hypodynamic lifestyle;
• Bekhterev's disease;
• osteoporosis;
• osteomalacia due to menopause in women;
• curvature of the spine in the form of flattened lordosis in the lumbar region, severe kyphosis of the coccygeal region;
• destruction of the knee or hip joints, which leads to improper distribution of the load;
• intense sports activities;
• hard physical labor;
• genetic predisposition.

To the great regret of specialists, in the last 5–10 years, bilateral sacroiliac arthrosis has been increasingly diagnosed in young people aged 25–35 years. Previously, the disease was considered characteristic of people over 55 years of age. Statistics show that SIJ most often affects women. Doctors explain this by processes associated with childbirth, as well as with anatomical features.

Treatment of sacroiliitis

The main goal is to eliminate the cause of inflammation.

Working with the patient involves the use of mainly conservative methods, however, surgical interventions can also be used (for purulent forms), which involve opening the purulent focus and removing the affected tissue.

The methods used, the volume and duration of treatment procedures are determined based on the results of confirming the diagnosis, on an individual basis, taking into account the existing characteristics of a particular patient.

Drug treatment of sacroiliitis

Various groups of drugs are used, which may include painkillers, hormonal/non-hormonal anti-inflammatory drugs (NSAIDs), immunomodulators, as well as broad-spectrum antibiotics and chondroprotectors.

Particular attention should be paid to chondroprotectors, the action of which can accelerate regeneration and ensure high-quality restoration of articular tissues.

Physiotherapy

Physiotherapeutic techniques are used exclusively in conjunction with the use of medications. A complex of this kind makes it possible to limit changes occurring in the tissues of the joint, which also helps to maintain its mobility.

The acute and subacute period involves the use of techniques such as electrophoresis and ultraphonophoresis, implemented with the use of drugs.

Other procedures used during recovery include exposure to magnets, laser or infrared radiation, massages, and other specific therapies (mud therapy, steam therapy, etc.).

Forecast

As a rule, with infectious causes and timely treatment of sacroiliitis, against the background of intact immunity, the prognosis is favorable. If there is a violation of the biomechanics of the joint and muscle fatigue, with the development of an aseptic process, the treatment is longer, including massage, exercise therapy, and physiotherapeutic procedures.

Finally, “rheumatic” sacroiliitis - symptoms, treatment, prognosis of the course of which indicates damage to the connective tissue - can last for many years. Everything will depend on the activity of the autoimmune process.

Danger and forecasts

The disease extremely rarely acts as an independent pathology, being in most known cases a symptom. Lack of timely diagnosis can lead to a sharp deterioration in the mobility of the spinal column. There are real risks of achieving a situation of complete immobility and disability of the patient.

Timely elimination of pathologically dangerous causes for joint tissues and the use of correct therapy will lead to favorable prognoses.

The method and timing of treatment are determined taking into account the existing clinical picture and the characteristics of the individual patient.

Folk remedies

At home, for this purpose, it is recommended to use rubs, ointments, and compresses based on various components. If discomfort occurs in the lumbar segment, you can use a compress of cabbage leaves with honey. You need to lubricate the leaf of this vegetable well with honey and apply it as a compress to the affected area and insulate it. It is better to perform the procedure before bedtime. In the morning, wash off everything with warm water.

Compresses for the treatment of arthritis will help relieve pain and block the development of inflammatory processes

Horseradish compress has a good healing effect. This product provides excellent warmth and also helps relax the muscles around the inflamed joint. This remedy enhances blood transport to the affected organ. For the procedure, take the crushed product, heat it in a water bath, smear a cotton cloth, and then apply it to the iliac bones before going to bed.

Herbal ointments can relieve pain and reduce inflammation. To prepare the medicine, you will need to mix calendula, chamomile and burdock roots in equal proportions. Use Vaseline as an ointment base. The mixture must be left for 24 hours. Apply the product with light massaging movements to the sacral and iliac vertebrae.

Traditional healers recommend fighting this pathology by combining mumiyo and honey. These remedies quickly eliminate discomfort due to arthrosis. For the procedure you will need 3 g of mumiyo, which must be mixed with honey. Apply the mixture to the sacroiliac joint area.

Along with external effects on pathology, herbalists recommend using medicinal drinks from the following plants:

• St. John's wort;
• Calendula;
• Birch leaves;
• Willow bark;
• Lingonberry leaves;
• Nettle and cinquefoil;
• Hop cones;
• Dandelions and clover;
• Daisies.

A weak solution of mumiyo, which should be taken orally, 1 tbsp, promotes rapid recovery. l. at a concentration of 0.3% on an empty stomach, as well as before bedtime. You can use crushed egg shells before dinner.

Prevention of sacroiliitis

Everyone knows that it is worthwhile to treat any disease in a timely manner, at the initial stages of its progression, or better yet, long before its onset, which can be real thanks to the observance of preventive measures, which usually include:

• monitoring general health, monitoring well-being;
• timely, complete treatment of various types of infections;
• protecting the body from overheating/hypothermia;
• creating conditions for strengthening and maintaining an optimal level of immunity.

Remember the benefits of leading an active lifestyle, ensure a balanced daily diet and enjoy all the pleasures of life without having to deal with various diseases.

Avoid self-medication and if any symptoms appear, please seek qualified medical help.