What is sacroiliitis: symptoms of the disease and treatment methods

The area where the pelvis connects to the spine experiences significant stress when moving and changing body positions. Therefore, the inflammatory process of the sacroiliac joint, or sacroiliitis, occurs quite often. Its designation in the International Classification of Diseases ICD-10 is M46.1. The disease can be independent or a side effect of tumor processes, infectious or autoimmune problems. A significant number of cases of lumbar sacroiliitis are observed in patients who were previously diagnosed with tuberculosis or syphilis. Depending on the cause that caused the appearance of painful symptoms, the nature and severity of the inflammatory process are distinguished.

Causes

The inflammatory process of the sacroiliac joint of bone tissue can be primary or secondary. The first is a local pathological process between the spinal column and the pelvic bones. It is provoked by tumor cells, infections and the consequences of untreated injuries. The secondary form is considered a side effect of infection or the development of connective tissue pathology, which results in rheumatic diseases.

The development of primary sacroiliitis is most often caused by:

• injuries to muscle and bone tissue in the lumbar and sacral region;
• benign and malignant neoplasms in the lower back that have metastasized to nearby tissues;
• infection of the pelvic area and lower back, consequences of purulent accumulations and damage to the skin.

According to medical statistics, primary tumors are more often caused by metastases from other organs: lungs, intestines or reproductive system. In the area of ​​​​the articular connection of the pelvis and spine, the tumor process occurs relatively less frequently. The presence of metastases indicates a long development of the disease and indicates its chronic nature.

Secondary sacroiliitis of the hip joint is usually caused by pathologies such as types of arthritis, psoriasis, spondyloarthritis, infectious diseases: tuberculosis, syphilis, brucellosis. Each of the listed disease processes causes tissue suppuration, which is catalyzed by pathogens of infectious diseases. If there are signs of rheumatism, the patient experiences an aseptic inflammatory process, which has a negative effect on the condition of bone tissue and joints.

Diagnosis of sacroiliitis

To make a diagnosis and determine the cause of the disease, in addition to questioning, general examination, palpation (characterized by pain in the sacral area), percussion, auscultation, additional research methods are used. Laboratory tests include blood and urine tests - in plasma you can determine an increase in leukocytes, erythrocyte sedimentation rate, and C-reactive protein. If the rheumatic nature of sacroiliitis of the sacroiliac joint is suspected, a test for the presence of specific antibodies and genes is prescribed.

Instrumental techniques include radiography, which is an informative, financially accessible and widespread method. It allows you to see a decrease in the clearance between the articular surfaces, minor damage and gradual destruction of cartilaginous structures, changes in the structure of the pelvic bones - they become denser, signs of inflammation around the lesion. In some forms of sacroiliitis, pathological changes will not be noticeable on x-ray - this may indicate the initial stage of development of the disease or confirm that the etiological factor is brucellosis.

Symptoms

The first sign of the disease, which makes one aware of a pathological process in the lower back, is severe pain. Their intensity and degree of manifestation depend on the cause that caused the inflammatory process of the articular joint.

If sacroiliitis is caused by the development of systemic diseases, patients complain of:

• bilateral nature of the pain (with bilateral sacroiliitis), indicating damage to the sacroiliac joint to the right and left of the spine;
• intense pain in the lower back, radiating to the buttocks, groin area or thigh tissue;
• a sharp increase in pain during night sleep or prolonged rest;
• reduction of discomfort during intense physical activity and exercise;
• limited movement in the morning immediately after waking up.

If the development of inflammation in the joints is caused by infectious processes in the body, patients note symptoms such as:

• unilateral damage to the sacroiliac joint to the right or left of the spine (unilateral sacroiliitis);
• intense pain in the lumbar region, radiating to the leg;
• increased pain with increased physical activity, when pressing on a joint or trying to move the leg to the side;
• reduction in the intensity of pain during long periods of rest;
• swelling of the tissues in the sacral area, severe hyperemia and increased skin temperature.

When suppuration develops, patients complain of a tugging pain, which allows the doctor to accurately diagnose sacroiliitis and take measures to eliminate it. If the inflammatory process during sacroiliitis is caused by injury to bone tissue, examination of the body may reveal fractures of the pelvic bones and damage to muscle fibers.

Risk factors

In most cases, inflammation of the sacroiliac joint is diagnosed:

• in the presence of untreated traumatic lesions in the lumbar region;
• if the patient refuses treatment for complex infectious diseases;
• in case of development of tumor processes in the pelvic and peritoneal organs;
• with decreased immunity due to serious illnesses;
• in case of congenital or acquired joint pathologies.

The listed situations indicate the need for regular preventive examination and visiting a doctor for any signs of the development of pathological processes in the lumbar region, bone joints of the pelvis and spine. This will allow you to detect the disease at an early stage and achieve 100% relief from its dangerous symptoms.

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Degrees and stages of sacroiliitis

Considering the localization of inflammation and destructive changes, in medicine it is customary to distinguish unilateral left- or right-sided sacroiliitis, and its bilateral form.

Taking into account the x-ray picture, the disease can be of stages 1, 2, 3, 4, namely:

1. – blurred contours are noted, the joint space expands, signs of sclerosis are revealed;
2. – surface defects appear, sclerotic changes are clearly visualized, the increase in the size of the space between the articular surfaces is uneven;
3. – pronounced sclerosis and formation of erosions, narrowing of the joint space, the first manifestations of ankylosis;
4. - the space between the bone joints disappears, as do their articular surfaces - this is a symptom of complete immobility of the sacroiliac joint.

Depending on the clinical picture, the doctor can diagnose sacroiliitis grades 1, 2, 3, 4, which correspond to the following symptoms:

1. – slight discomfort in the back area;
2. – pain in the lumbar spine, which radiates to the hips and buttocks;
3. – severe pain, convulsive attacks, myalgia, impaired spinal mobility;
4. – complete immobility of the joint, high risk of complications.

Classification

In order to develop more effective treatment tactics, the following classification methods are used:

• depending on the area of ​​damage to the joint, they distinguish between synovitis (the inner layer of the joint capsule is affected), osteoarthritis (the disease affects the cartilage tissue) and panarthritis, when the inflammatory process affects the entire joint;
• Taking into account the nature and characteristics of the course, patients are diagnosed with purulent, subacute or chronic sacroiliitis. The first case is often the result of traumatic tissue damage, and the third is a consequence of infection of the body. Subacute sacroiliitis occupies an intermediate position between the acute and chronic stages, differing from the latter in more pronounced symptoms.

Complications of sacroiliitis 2 and 3 degrees

Further development of the inflammatory process without proper treatment and specialist supervision becomes the cause of a number of pathological conditions:

• suppuration can affect healthy tissues of the hip, back and lower extremities;
• inflammation of the joint impairs the nutrition of tissues, which can cause their gradual death and destruction;
• the development of the disease often acts as a factor in limiting the mobility of the joint and limb;
• disruption of the articular joint is often the cause of its destruction with subsequent immobilization of the patient.

Also, due to joint pathology, the risk of developing osteoporosis increases.

Sacroiliitis in children and pregnancy

In childhood, the cause of the disease may be congenital developmental anomalies and the formation of anatomical and physiological structures of the musculoskeletal system during the period of intrauterine growth. The clinical picture is similar to that in adults. For diagnosis, X-ray methods, MRI and CT can be used for sacroiliitis. Treatment has medicinal and surgical directions.

There are theories that in women carrying a fetus, the risk of the disease increases due to the high load on the spinal column, due to changes in the position of bone structures, and an increase in body weight. Symptoms manifest themselves in pain, stiffness and rigidity of movements, and sometimes a typical duck gait occurs.

This disease is not an absolute contraindication to natural birth, however, many women are recommended to have a cesarean section - this issue is decided by the attending physician based on the individual characteristics of the woman in labor, her well-being, and the severity of the condition. Often, after childbirth, sacroiliitis does not bother young mothers as much as their body begins to recover, take on its previous shape, and the load decreases.

Treatment

The course of drug treatment for sacroiliitis includes taking antibiotics, anti-inflammatory drugs and corticosteroids. When choosing appropriate medications, the doctor takes into account the age and general condition of the patient’s body, the degree of damage to the joint and the characteristics of the course of the disease. When diagnosing complex purulent inflammation, surgical intervention is indicated.

If sacroiliitis is detected at the initial stage, the patient is guaranteed a complete cure while maintaining mobility and integrity of the joint. If the chronic stage develops, the likelihood of eliminating symptoms directly depends on the extent of inflammation and destruction of the articular joint.

Treatment of sacroiliitis

Therapeutic measures can be conservative or surgical - this depends on the characteristics of the course of the disease. Prescribed medications include the following pharmacological groups:

• non-steroidal anti-inflammatory drugs;
• antibacterial drugs;
• corticosteroid drugs;
• immunosuppressive medications.

Physiotherapeutic procedures using a magnetic field, electrophoresis, ultraviolet radiation, therapeutic baths, and massage for sacroiliitis are also used.

Surgical tactics for patient management involve surgical intervention; the main indication is a purulent inflammatory process. It is based on removing areas that have succumbed to pathological changes and destruction, cleansing the area from pus-containing fluid, washing the wound with antiseptic substances and applying a sterile bandage.

To increase the effectiveness of therapy, special exercises and diet are prescribed for sacroiliitis, the latter involves eating foods rich in vitamins and microelements necessary for the normal functioning of bones, cartilage and joints.

How to make an appointment with a rheumatologist at JSC "Medicine" (clinic of academician Roitberg)

To be examined by a qualified rheumatologist or traumatologist and receive recommendations for the treatment of sacroiliitis in our clinic, you can call +7 (495) 775-73-60. You can apply for an appointment online using the contact form on the website. Be sure to include your current phone number so that a call center employee can contact you and confirm your appointment time.

The clinic is located at the address: Central Administrative District, 2nd Tverskoy-Yamskaya Lane, 10. For those who travel by public transport, it is more convenient to get to the medical center from the Mayakovskaya, Belorusskaya, Novoslobodskaya, Tverskaya, Chekhovskaya metro stations.

Complications and consequences of sacroiliitis

The danger of the disease lies in the spread of the lesion to other organs and systems - this is typical for purulent forms, in which a breakthrough of the pathology is detected and its movement to the spinal cord, that is, damage to the central nervous system. There may be purulent leaks that break into the buttock and pelvic areas. If the cause of the disease is a rheumatological disease, there is a high risk of impaired mobility of the spinal column, which is an indication for the disability group for sacroiliitis.