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) not necessary if diagnosis of ankylosing spondylitis has already been confirmed (see Radiology below)
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
- partial fusion of the sacroiliac joints bilaterally confirms diagnosis of ankylosing spondylitis[1]
- 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
- when radiographic changes negative, MRI positive, referred to as nonradiographic axial spondyloarthritis
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
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2021
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ UpToDate 13.3 http://www.utdol.com
- ↑ 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://pubmed.ncbi.nlm.nih.gov/15711787
- ↑ 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://pubmed.ncbi.nlm.nih.gov/15690213
- ↑ 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://pubmed.ncbi.nlm.nih.gov/15653983
- ↑ 6.0 6.1 6.2 Internal Medicine News, April 1, 2008
- ↑ 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://pubmed.ncbi.nlm.nih.gov/30045603 Free article.
- ↑ NEJM Knowledge+
Wordsworth P. Arthritis and inflammatory bowel disease. Curr Rheumatol Rep. 2000 Apr;2(2):87-8. PMID: https://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/3289378 Review. - ↑ Kameda H, Kobayashi S, Tamura N, et al. Non-radiographic axial spondyloarthritis. Mod Rheumatol. 2021;31:277-282. PMID: https://pubmed.ncbi.nlm.nih.gov/32996809