Overview
What is Sacroiliitis?
Definition
Classification
Questions you may be concerned about
Where does sacroiliac arthritis hurt?
Sacroiliac arthritis pain often occurs in the low back, buttocks, but also in the legs, groin, and usually not below the knee.
The pain can be unilateral or bilateral.
The nature of the pain tends to be a constant dull ache that occurs after activity and is relieved by rest.
In severe cases, the pain can occur at rest, worsened by activity, weight-bearing, or even wake up at night.
It may be accompanied by lumbosacral pressure pain and activity limitation.
Is the prescription for sacroiliac arthritis really effective?
Treatment of sacroiliac arthritis should be standardized under the guidance of a professional doctor, do not believe in local remedies, secret recipes, prescriptions and other unidentified treatment methods.
The treatment of sacroiliac arthritis includes rest, physical exercise, medication (e.g. non-steroidal anti-inflammatory drugs, muscle relaxants, etc.), physical therapy, and surgery.
Sacroiliac arthritis caused by other diseases also requires active treatment of the primary disease in order to control the condition fundamentally.
What is the most contraindicated for sacroiliac arthritis?
Sacroiliac arthritis is contraindicated by cold, heavy labor should be minimized to avoid injury, and diet should be light.
Patients should pay attention to keep warm to avoid getting cold.
Activities in which the lumbosacral region is subjected to gravity should be minimized so as not to aggravate the symptoms of sacroiliac arthritis.
Care should be taken to protect the sacroiliac joints to avoid injury.
Diet needs to be light, no spicy and stimulating food, no smoking, no alcohol, more fresh fruits and vegetables.
Causes
Causes
Primary sacroiliac arthritis
The cause of the disease is not yet clear, and it is thought that it may be related to age, physical fitness and genetic factors.
Secondary sacroiliac arthritis
It is related to a variety of internal and external factors, or may be caused by the interaction of the two.
External factors
Internal factors
Pathogenesis
The stability of sacroiliac joint itself is very high, but under the influence of certain factors (e.g. trauma, age, medical injury, etc.), the articular surface is displaced, loosened and rotated, so that the stability of the sacroiliac joint is damaged, and the metabolic microenvironment is changed to stimulate the surrounding tissues, which triggers sacroiliac arthritis. It is more likely to develop if it is further stimulated by certain internal factors.
Symptoms
Main Symptoms
Pain
It is the main and most common symptom.
The pain often occurs in the lower back, buttocks, but can also be found in the legs, groin, and usually not below the knee.
The pain can be unilateral or bilateral.
The nature of the pain tends to be a constant dull ache that occurs after activity and is relieved by rest.
In severe cases, the pain can occur at rest, worsened by activity, weight-bearing, or even wake up at night.
It may be accompanied by lumbosacral tenderness and limitation of movement.
Morning stiffness
Morning stiffness occurs in the lumbosacral area after waking up in the morning, and the stiffness and limitation of activity will be gradually relieved after activity.
The duration of morning stiffness is relatively short, usually less than 30 minutes.
Other symptoms
With the aggravation of the disease, spasmodic contraction of the muscles around the joints and mechanical atresia may occur, resulting in impaired lumbosacral movement.
Some may have mild systemic symptoms, such as fatigue, emaciation and mild anemia.
Consultation
Department of Medicine
Orthopedics
If there is persistent dull pain in the lower back or buttocks, aggravated by movement or weight-bearing, and stiffness of joints, it is recommended to consult a doctor promptly.
Preparation
Consultation: Registration, Preparation of Information, Frequently Asked Questions
Tips for seeking medical treatment
If you have many clinical symptoms, you should try to record the symptoms you have experienced and the characteristics of the episodes, etc., so as to give the doctor more references.
Family members are recommended to accompany the doctor, avoid driving or riding to the doctor by yourself.
Preparation List
Symptom list
Especially focus on the time of symptom onset, special performance, etc.
Are there any symptoms such as joint pain, pressure pain, limitation of movement? Which part of the body is it in?
How long have the symptoms lasted?
Under what circumstances do the joint pain or limitation of movement worsen or decrease?
Is it accompanied by generalized weakness, emaciation, etc.?
List of medical history
Is there a history of trauma to the lower back or buttocks? How was the injury sustained?
Does anyone in the family have sacroiliitis?
Any congenital sacroiliac joint lesions, ankylosing spondylitis, rheumatoid arthritis, multiple myeloma, etc.?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Imaging examination: X-ray examination, CT examination, magnetic resonance imaging examination
Laboratory tests: blood tests, rheumatoid factor test, C-reactive protein test, tuberculin test, human leukocyte antigen B27 (HLA-B27)
Medication List
Medication used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
Analgesics (oral): aspirin, acetaminophen, ibuprofen, celecoxib
Muscle relaxants (oral): cloxazone, tizanidine, flupirtine
Diagnosis
Diagnosis is based on
The history and clinical presentation of sacroiliac arthritis are not specific, and imaging is needed to make a definitive diagnosis.
History
Some may have a history of trauma, chronic strain, family history, certain congenital, immunologic, metabolic, or infectious diseases, tumors, or a history of long-term medication or surgery.
Clinical manifestations
Symptoms
Chronic pain in the lower back, buttocks or legs, morning stiffness in the lumbosacral region.
Physical signs
Doctors conduct physical examination by visual inspection and palpation, during which the following signs will be found, which will help to clarify the diagnosis.
Lumbosacral pressure and pain, limited mobility of sacroiliac joints.
Piedallu’s sign: unilateral onset of the disease may appear bilateral posterior superior iliac spine is not on the same level, in general, the onset of the side is low; waist forward bending, the position of the posterior superior iliac spine of the diseased side is elevated more than that of the healthy side.
Positive sacroiliac joint separation test (4-word test): when lying on the back, with the lower limbs in a special position resembling the word “4”, if the doctor presses on the sacroiliac joints, there will be pain, or a certain side of the knee joint can not touch the surface of the bed.
Positive hip hyperextension test, Gaenslen test, etc.
Laboratory Tests
Routine blood tests
Routine blood tests can clarify the presence or absence of infection through indicators such as white blood cell count.
The white blood cell count is usually within the normal range, but may increase when there is an infection.
Other tests
Since a variety of diseases can cause sacroiliac arthritis, C-reactive protein, anti-tuberculosis antibody, human leukocyte antigen B27 (HLA-B27), rheumatoid factor and other indicators, anti-streptococcal hemolysin O test, tuberculin test, etc., are also needed to clarify the cause of the disease and differential diagnosis.
Imaging examination
X-ray examination
Currently, X-ray examination is only used for initial clinical screening and cannot be used for confirming the diagnosis.
X-ray examination can find out whether the edge of sacroiliac joint is clear, whether there is any bone damage, joint space changes, etc. The structure of sacroiliac joint is complex.
The structure of sacroiliac joint is complex, and X-ray examination cannot avoid the overlapping of bony structures, which will affect the observation of the lesion.
CT examination
CT examination is a more commonly used examination tool, which not only helps to diagnose sacroiliac arthritis, but also helps to observe the treatment effect.
The image data obtained by CT examination is clearer than that of X-ray examination, which can show the degree of lesions and characteristics of lesions in the sacroiliac joint and its surrounding tissues more clearly.
Magnetic resonance imaging (MRI) examination
MRI examination is helpful for the early diagnosis of the disease.
MRI has the advantages of clear, fine, high resolution and large amount of information, which can better evaluate the abnormalities of the sacroiliac joint and its surrounding soft tissues.
Others
Drug injections into the sacroiliac joints under fluoroscopy can be both therapeutic and diagnostic, but are usually only used in recalcitrant cases.
Differential Diagnosis
Sacroiliac joint strain
Similarities: Both can present with symptoms of chronic lumbosacral pain that can be exacerbated by activity.
Differences: Sacroiliac joint strain is a simple chronic strain that has not yet developed into sacroiliac arthritis, and there are no specific changes on X-ray.
Lumbar disc herniation
Similarity: pain in the lumbar, hip and leg areas.
Differences: Lumbar disc herniation can also have unilateral and bilateral lower limb numbness, weakness and other nerve root compression symptoms, severe cases may appear incontinence, sensory abnormalities, etc. Imaging examination can find lumbar disc herniation, sacroiliac joints have no abnormal changes.
Treatment
Purpose of treatment
Eliminate or minimize pain, morning stiffness and other symptoms, restore joint function, prevent further development of the disease, and improve and enhance the quality of life.
Treatment method
General treatment
Regular diet, work and rest, and pay attention to the combination of work and rest.
Pay attention to maintaining the correct posture in walking, standing, sitting and lying down, and pay attention to lifting the chest and tightening the abdomen, and avoid sitting for a long period of time.
Avoid triggers such as cold, infection, excessive weight bearing and strenuous exercise.
Quit smoking and drinking.
Physical exercise can maintain the normal range of motion and function of the sacroiliac joints, keep the flexibility of the joints, increase muscle strength and make the joints more stable. Exercise should be chosen under the guidance of doctors to avoid aggravation of the condition by wrong exercise.
Medication
Analgesics
Only relieve the symptoms of pain and morning stiffness, and cannot control or stop the aggravation of the condition.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs have analgesic and anti-inflammatory effects, and are more effective in treating acute attacks of sacroiliac arthritis resulting in pain in the lumbar and hip areas.
Commonly used drugs are ibuprofen, acetaminophen, indomethacin, loxoprofen, celecoxib, naproxen, meloxicam, and diclofenac.
It should be noted that some people who take NSAIDs have adverse reactions such as nausea, vomiting, and other stomach upset.
People with stomach ulcers and bleeding should avoid taking these drugs.
Others
For those who are not well treated with NSAIDs, have contraindications to the drug and/or cannot tolerate it, opioids (e.g., pethidine, fentanyl) may be considered for analgesia.
Muscle relaxants (referred to as myorelaxants)
If accompanied by muscle spasms, muscle relaxants may be used to relieve symptoms.
Commonly used drugs include chlorzoxazone, tizanidine, flupirtine, etc.
Others
Sacroiliac arthritis caused by other diseases also requires corresponding special medication to control the condition fundamentally, e.g. ankylosing spondylitis requires the application of anti-rheumatic drugs such as tumor necrosis factor inhibitors, salazosulfapyridine, leflunomide and methotrexate.
Glucosamine, chondroitin sulfate, bivalirudin and other chondroprotective agents may have a certain therapeutic effect, the specific efficacy of the academic community has not yet reached a consensus.
Special Reminder
All drugs should be applied under the guidance of a doctor, avoid self-application or changing the dosage of drugs.
Physical therapy
Physical therapy can relax spastic muscles and relieve pain. It can also help to maintain the range of motion of the joints, keep them functioning properly and prevent progression of the disease.
Heat therapy (e.g. hot water bath, spa bath), ultrasound, nerve electrical stimulation and other methods may be used.
Different treatments are suitable for different people and will be chosen by your doctor according to the situation.
Surgical treatment
Surgery may be considered for patients who have had poor results with non-surgical treatment methods.
The purpose of surgery is to eliminate pain and other symptoms and improve joint function.
The main surgical method is arthroplasty.
Complications such as joint non-healing, infection, bleeding and nerve damage may occur after surgery.
Other treatments
Injection of local anesthetics + glucocorticoids into the sacroiliac joint cavity can also effectively relieve symptoms, but it is usually only used for diagnosis and persistent cases, and should not be used for a long period of time.
Diversified Chinese medical treatments such as herbal prescriptions, herbal fumigation, herbal baths, hot compresses, hot irons, compresses, rubbing, kneading, and needling, etc., also have a certain degree of therapeutic effect. If you want to choose Chinese medicine treatment, it is recommended to go to a hospital with formal qualifications.
Prognosis
Cure
Sacroiliac arthritis cannot be cured by itself, and the final prognosis is closely related to the cause of the disease.
If the cause of the disease can be removed, after early diagnosis and active standardized treatment, the symptoms can be significantly relieved and the prognosis is better.
If the cause of the disease is difficult to remove, standardized treatment can also relieve symptoms and slow down the progress of the disease.
Harmful
Long-term persistent pain, morning stiffness and other manifestations, affecting normal joint activities, will also affect daily work and life.
Long-term persistent pain can affect mental health, resulting in depression such as low mood and sadness.
Long-term limitation of activities will cause muscle atrophy, muscle tissue laxity, muscle strength weakening and so on.
Gradual progression of the disease, there will be muscle contracture around the joints, joints can not move normally, there is a certain degree of disability.
Daily
Daily management
Sacroiliac arthritis patients should improve their lifestyles in their daily lives, as well as pay attention to diet, emotions, and follow-up appointments.
Dietary management
Pay attention to less salt and oil.
Avoid raw, cold, greasy, spicy and irritating foods.
You can choose foods such as milk, soy products, eggs and lean meat.
Drink more water as appropriate.
Abstain from alcohol.
Psychological support
After the disease, you should learn more about the nature of the disease, the general course of the disease, the prognosis and other knowledge to enhance the confidence and patience in treating the disease.
Maintain optimism, eliminate tension, anxiety, depression, fear and other negative emotions.
Talk to your friends and relatives when you are troubled, listen to soothing music or get close to nature, and seek professional help if necessary.
Lifestyle management
Maintain a regular routine and avoid staying up late.
Keep warm and add more clothing in cold weather.
Reduce the intensity of your labor if you have been doing manual labor for a long time.
Sedentary people should pay attention to changing their postures frequently.
Physical exercise should be gradual and prevent excessive joint movement and weight bearing.
Maintain a healthy weight, overweight people should control diet, exercise to reduce weight, the choice of exercise can consult a rehabilitation physician and other professionals.
Smoking cessation.
Follow-up
Regular follow-ups are helpful to observe changes in your condition so that your doctor can adjust your treatment plan.
You should follow the doctor’s instructions and bring your medical records and examination reports with you.
If your symptoms do not subside or even worsen, you should consult your doctor.
Physical examination and X-ray examination may be done during the follow-up visit, so please be prepared for them.
Prevention
Safety
Pay attention to your safety in your daily life and avoid injuring your joints due to traffic accidents or falls.
Obey traffic rules and avoid driving against the flow of traffic.
Take precautions when driving or taking transportation, such as wearing a helmet when riding a motorcycle or fastening a seat belt when riding in a car.
Avoid physically demanding sports or wear protective gear when playing sports.
Maintain a good lifestyle
Maintain the correct posture in walking, standing, sitting and lying down, pay attention to the chest and abdomen, and avoid sitting for a long time.
In terms of daily diet, pay attention to balanced nutrition and ensure the intake of protein, vitamins and other nutrients.
Exercise appropriately to improve physical fitness and resistance, but exercise time and intensity should be gradual and avoid excessive exercise.
Maintain a healthy body weight. Those who are overweight should take measures to lose weight slowly.
Others
Reasonable use of medication: medication should be used under the guidance of a doctor and regular review should be conducted according to the doctor’s advice during the period of taking medication.
Active treatment of primary diseases: If you are found to be suffering from ankylosing spondylitis, rheumatoid arthritis, hyperparathyroidism, perimenopausal syndrome, gout, infections, etc., you should standardize the treatment in a timely manner and undergo regular checkups.