sacroiliitis
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Introduction
Inflammation of the sacroiliac joint.
Etiology
- ankylosing spondylitis & other spondyloarthropathies
- reactive arthritis
- familial Mediterranean fever[3]
- granulomatous disease: tuberculosis[4], sarcoidosis[5]
- trauma: unidirectional shear forces such as stepping off a curb[1]
- idiopathic
Epidemiology
- up to 15% of low back pain[6]
Clinical manifestations
- low back pain & stiffness
- with or without tenderness over the sacroiliac joints
- may be asymptomatic
- poorly localized buttocks pain, & inability to bear weight
- involvement may initially be unilateral, but invariably becomes bilateral
- referred pain to the groin or thigh may be present[6]
- positive FABER test, Patrick's test & Gaenslen's test
- no pain with passive range of motion of the hips
Laboratory
- HLA-B27 in blood (prior to MRI of sacroiliac joint)
Radiology
- radiographic changes generally more prominent on the ilial side of the joint
- periarticular arthritis
- loss of definition of joint line
- pseudowidening of the joint
- later changes
- eburnation of surrounding bone
- sclerosis progressing to ankylosis
- radionuclide techniques may show early changes, but are relatively non-specific
- magnetic resonance imaging (MRI)
- indicated when plain radiographs are negative & index of suspicion is high
- shows increased T2-weighted signal from bone & bone marrow suggesting edema
Complications
- progression to ankylosing spondylitis[7]
Differential diagnosis
Management
- treatment of specific etiology
- rest
- non-steroidal anti-inflammatory drugs (NSAIDs)
- consider physical therapy
- glucocorticoid injection for patients not responding to conservative therapy[1]
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2021
- ↑ UpToDate 13.3 http://www.utdol.com
- ↑ Jump up to: 3.0 3.1 Balaban B et al Sacroilitis in familial Mediterranean fever and seronegative spondyloarthopathy: importance of differential diagnosis. Rheumatol Int 2005; 25:641 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15711787
- ↑ Jump up to: 4.0 4.1 Papagelopoulos PJ et al, Tuberculous sacroiliitis: A case report and review of the literature. Eur Spin 2005;14:683 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15690213
- ↑ Jump up to: 5.0 5.1 Erb N et al, An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis Chest 2005; 127:192 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15653983
- ↑ Jump up to: 6.0 6.1 6.2 Internal Medicine News, April 1, 2008
- ↑ Jump up to: 7.0 7.1 Wang R et al. Progression of nonradiographic axial spondyloarthritis to ankylosing spondylitis: A population-based cohort study. Arthritis Rheumatol 2016 Jun; 68:1415
- ↑ Telli H, Telli S, Topal M. The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction. Pain Physician. 2018 Jul;21(4):E367-E376. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30045603 Free article.
- ↑ NEJM Knowledge+
Wordsworth P. Arthritis and inflammatory bowel disease. Curr Rheumatol Rep. 2000 Apr;2(2):87-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11123044 No abstract available.
Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol. 1988 Jul;83(7):703-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/3289378 Review.