Scare Away Sacroiliitis

You have pain in your butt and lower back which seems to get worse from sitting for long periods of time or climbing stairs. You could have sacroiliitis.

Sacroiliitis describes inflammation leading to pain in the sacroiliac joint that attaches to the sacrum, the lowest part of the spine, to the pelvis.

It is important to know that for people under age 60, there is always an underlying condition present like inflammatory bowel disease, ulcerative colitis and Crohn’s disease, psoriasis and a condition called ankylosing spondylitis.

Sacroiliitis can happen as a complication of infections in the heart, skin, joints or muscle. It can also follow an injury to the back and is more common in those that use illicit drugs. This form of back pain is a frequent complication of pregnancy as the pelvis stretches to accommodate childbirth.

In older persons, the major effect is osteoarthritis that is similar to that occurring in many other joints.

In a typical patient, the symptoms can happen very suddenly with pain that is localized to one side of the back. The pain can be unbearable to the touch and the patient will not allow close examination of the affected area.

Here any form of movement of the spine becomes very intolerable and painful. Sometimes the pain is felt in the thigh and in the buttock.

Pain in the joint leads to an ache of the muscles surrounding the joint that in turn can cause the compression of the sciatic nerve leading to pain that radiates down the leg and on occasion numbness in the foot or leg.

This can result in limping.

The most acute forms of sacroiliitis are related to the medical conditions listed above. There may be fever, inflammation of the eye, evidence of psoriasis—with an obvious skin rash—or inflammatory bowel disease that shows abdominal pain and diarrhea containing blood and mucus.

In the older patient, the pain may be quite serious but is more often persistent presenting with back pain that may have been present for weeks, months and even years. A prominent feature of the pain is that is made worse by sitting or lying down and is made better by standing up.

Quite frequently, sacroiliac pain is confused with another reason for low back pain, such as a ruptured disk, collapsed vertebra, spinal stenosis or osteoarthritis of the joints in the spinal cord.

A good way to narrow down sacroiliac pain is to sit down, and if the pain is on the right side of your back, place the ankle of your right leg over the knee of your left leg. And then position your right knee downwards.

If this causes pain, the likely culprit is the sacroiliac joint. Your doctor should also closely examine your back and press on the affected joint, which of course will result in pain and an accurate diagnosis.

Treatment for sacroiliitis consists of over-the-counter medications such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and naproxen sodium (Aleve). Your physician may also prescribe muscle relaxers like cyclobenzaprine (Amrix) and biologics such as interleukin-17 (IL-17) inhibitors like secukinumab (Cosentyx) and tumor necrosis factor (TNF) inhibitors like etanercept (Enbrel).

Because failure to diagnose this condition is usual, it is important for every patient with back pain to be aware of the sacroiliac pain and discuss it as a possibility with his or her doctor.