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Sacroiliitis - what is it? Symptoms, treatment and prognosis

Many of us know the word "sacred", which can be translated into Russian as "sacred." By the way, in Latin, the sacral bone of our skeleton is called “os sacrum”. What could be sacred in the sacrum bone?

According to ancient beliefs, it was believed that for this one bone you can resurrect a person. In some modern religious movements of the pseudo-Hindu sense, it is believed that it is inside this bone (naturally, on the astral or subtle plane) there is the energy of "Kundalini".

Our task is simpler. We will not look for sacred images in the skeleton, but tell you what sacroiliitis is, what causes lead to it, how it is manifested and treated.


Sacroiliitis - what is it?


Sacroiliitis is an inflammation of the sacroiliac joints. Purely theoretically, the connection between the sacral bone and the iliac bones is attributed to the joints, but the connection between them is very tight, which is called amphiarthrosis.

This position of the sacrum, "stretched" between the iliac bones, allows you to close the pelvic bones into a single ring. The role of these “stretch marks” is played by the sacroiliac interosseous ligaments.

The sacroiliac ligaments are among the strongest in the body. Only the joints of the bones of the skull are stronger than them with the help of winding seams. But the bones of the skull grow together into a single conglomerate, and between the bones of the pelvis and the sacrum there are normally articular fissures.

The closest analogue of such a connection in the pelvic ring is the pubic joint, the rupture of which sometimes occurs during rapid delivery. This is a severe complication requiring urgent surgery.

  • The value of the sacroiliac articulation is very large: it centers and stabilizes the sacrum, which makes it possible to make it the pivot point of the entire spinal column, head, torso, internal organs and the belt of the upper extremities.

If you consider that a person puts on his lower, upper and winter clothes, and still carries loads - you can understand what kind of stress falls on the sacrum and on the sacroiliac joints.

  • Why is the significance of this inflammatory process so great for doctors?

Yes, because these joints (both left and right) belong to the axial skeleton. And if other joints are affected (rheumatoid or psoriatic arthritis), involvement of the sacroiliac joint (as well as temporomandibular joints) in the process indicates an increase in the severity of the process, and also allows you to take more serious measures during treatment.

Causes of sacroiliitis

There are two large groups of causes that lead to inflammation. The first is autoimmune diseases, in which there is a symmetric inflammation. This group stands alone because there are no particular problems in these joints, just inflammation is the “marker” of the systemic process.

The second group consists of diseases that cause ordinary arthritis and other localizations, but on the one hand. Most often, right-handed sacroiliitis develops in right-handers (since their supporting leg is also right, and it is more loaded), and left-handed sacroiliitis develops in left-handers.

In this case, this group of causes includes:

  • violation of joint biomechanics (for example, increased overload associated with shortening of the limb during inflammatory processes);
  • pregnancy;
  • postmenopausal osteoporosis in women;
  • congenital malformations (subluxations);
  • prolonged sedentary work, which leads to weakening of the pelvic ring;
  • tumors of the pelvic bones, retroperitoneal space and small pelvic cavity;
  • infectious lesions ( syphilis , Lyme disease).

Bilateral sacroiliitis

Bilateral sacroiliitis

When a bilateral sacroiliitis is detected, on the one hand, the diagnostic search is significantly narrowed, but on the other hand, it “turns” in the other direction.

So, traumatic, congenital and tumor disorders, and most of the infectious arthritis are likely to be excluded. After determining bilateral sacroiliitis in a patient, it is likely that an autoimmune disease (psoriasis complicated by arthritis) or ankylosing spondylitis is detected.

In rare cases, bilateral lesion of the sacroiliac joint may indicate an infectious process of brucellosis or tuberculosis etiology, which are also characterized by a symmetrical lesion.


Like many other lesions of the joints, sacroiliitis is divided into the following variants:

  • Specific. This means that the inflammation has any characteristic features by which it is possible to determine the cause with great certainty. Such sacroiliitis include tuberculous, syphilitic and brucellosis arthritis;
  • Nonspecific. The usual inflammatory process with the development of classical inflammation and the addition of suppuration. As a rule, it requires surgery, or a massive antibacterial and anti-inflammatory therapy, in order to do without surgical treatment in the early stages of the disease;
  • Aseptic process. That it is the basis of autoimmune inflammation, in which there is no microbial infection and suppuration.

Degrees of sacroiliitis

Since the main and fastest preliminary method for the diagnosis of sacroiliitis is X-ray, any pathological process in this joint can be “decomposed” in stages. There are four degrees of sacroiliitis:

  1. First degree: there is a moderate vagueness of the joint space, but still it is determined;
  2. The occurrence of sclerosis, the symptom of "strands of pearls", or signs of uzuratsiya (uneven expansion of the gap);
  3. The aggravation of symptoms and the appearance of the closure of the joint space - ankylosis;
  4. In the fourth degree, the articular fissure is completely closed, and the sacroiliac joint becomes a single bony character. Full ankylosis develops.

Symptoms of sacroiliitis

Symptoms of sacroiliitis photo

Symptoms of sacroiliitis photo

Since this is an inflammatory disease, the main symptoms of sacroiliitis are pain and impaired function. Most often, patients are concerned about the following complaints (the process can be both one-sided and symmetrical):

  • There is pain in the buttock, radiating to the thigh. When the straight leg is pulled back from the tension of the gluteus maximus, the pain increases;
  • Often there is the phenomenon of increased pain during exercise with severe signs of arthritis;
  • There is stiffness in various parts of the spine, most often in the mornings and in the lumbar region;
  • There may be pain in the sacrum, especially after exercise;
  • Facilitates the position of lying on your back with knees bent and legs apart. This posture relieves pressure on the sacroiliac ligaments.

The remaining signs of inflammation, such as redness, swelling of soft tissues, local feeling of heat during sacroiliitis, may be invisible, since this joint is “hidden” far from the surface of the body. Therefore, pain and dysfunction are the basis of clinical diagnosis.


In order for the doctor to refer the patient for an examination, in addition to the above symptoms, inflammation must be confirmed using routine laboratory tests. For example, can be identified:

  • peripheral blood leukocytosis;
  • leukocyte shift to the left, to the young, or even myelocytes;
  • increased ESR ;
  • positive immunodiagnostics data on a specific microorganism (in the case of a specific pathogen);
  • lesion of distant joints, the presence of skin rashes, dactylitis, lesion of nail plates (this occurs in psoriatic arthritis);
  • pronounced general reaction of the body: fever, intoxication, swelling of soft tissues, talking about diffuse inflammation - cellulitis in the intermuscular spaces of the pelvis.

The most rapid and informative diagnostic method, as already mentioned, is pelvic bone radiography with targeted, large-scale imaging of the sacroiliac joints in a direct projection with the mandatory seizure of two articular crevices along their entire length.

Magnetic resonance imaging is indicated for suspected soft tissue formations (of a paracancic nature, metastasis of tumors), as well as in determining tactics before the operation of draining extensive purulent foci in infectious complications.

Treatment of sacroiliitis - drugs and techniques

Treatment of sacroiliitis - drugs Treatment of sacroiliitis is not always aimed at sacroiliitis itself, and this is an important point. In the event that it is a marker of autoimmune inflammation, then “all at once” is treated, according to international schemes.

In this case, sacroiliitis only serves as definite evidence for the beginning of a more serious (basic) therapy.

For example, in psoriatic arthritis, the presence of sacroiliitis suggests the involvement of axial joints in the autoimmune process, which serves as an indication for the administration of cytostatics (for example, Methotrexate) and monoclonal antibodies (for example, Mabthera).

In the case of ankylosing spondylitis (ankylosing spondylitis), in which sacroiliitis is one of the leading symptoms of a lesion, specific therapy is also prescribed.

The treatment of other lesion options most often includes the rational use of antibacterial therapy (with determining the sensitivity of the pathogen), anti-inflammatory therapy, then a course of rehabilitation treatment (massage, physical procedures). Subsequent treatment is carried out by an orthopedist, an arthrologist.

In the case of an autoimmune process, the course is conducted by a rheumatologist, and for these diseases (Bechterew's disease, psoriasis), treatment is only conservative, no operations are indicated for sacroiliitis.

In case a patient has signs of sacroiliitis on a radiograph, he needs an urgent rheumatologist consultation. It is illiterate to begin treatment in the form of massages and physiotherapy by the therapist with this disease, or, moreover, to declare a narrowing of the joint cracks on the roentgenogram "a sign of osteochondrosis", since precious time can be missed. Sacroiliitis, whose treatment is neglected, can lead to disability and the development of ankylosis in completely different places.


As a rule, with infectious causes and timely treatment of sacroiliitis, against the background of the preservation of immunity, the prognosis is favorable. In case of violation of joint biomechanics and muscle fatigue, with the development of an aseptic process, the treatment is longer, including massage, exercise therapy, and physiotherapy procedures.

Finally, "rheumatic" sacroiliitis - symptoms, treatment, the prognosis of which indicates the defeat of the connective tissue - can occur for many years. Everything will depend on the activity of the autoimmune process.

Marinet Dupen-cheng
2017-03-11 15:07:58
thanks for the information it helped me a lot

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