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| ==Overview== | | ==[[Sacroiliitis overview|Overview]]== |
| '''Sacroiliitis''' is an inflammation of the [[sacroiliac joint]]. Inflammation may occur in the region of the sacroiliac joint. This joint is relatively inflexible and connects the sacrum to the pelvis. It is associated with a variety of infectious or inflammatory conditions. Pain occurs either unilaterally or bilaterally in the low back, buttock and upper leg.
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| ==Risk Factors for Sacroiliitis== | | ==[[Sacroiliitis pathophysiology|Pathophysiology]]== |
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| * A history of bone, joint or skin infections. Some people are more prone to infections, and an infection is one possible cause of sacroiliitis.
| | ==[[Sacroiliitis causes|Causes]]== |
| * Injury or trauma to your spine, pelvis or buttocks. Torn ligaments or trauma may create inflammation or infection of the [[sacroiliac joint]]s.
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| * [[Urinary tract infection]]. This infection may spread from your urinary tract, which includes your [[kidney]]s, [[bladder]] and [[urethra]], to your [[sacroiliac joint]]s.
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| * [[Pregnancy]]. The pelvic bone's expansion to prepare for childbirth may inflame the area around your sacroiliac joints.
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| * [[Endocarditis]]. This infection of your heart's inner lining may spread to your [[sacroiliac joint]]s.
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| ==Causes of Sacroiliitis== | | ==[[Sacroiliitis differential diagnosis|Differentiating Sacroiliitis from other Diseases]]== |
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| * Heavy lifting, especially incorrect training or when muscles aren't prepared for the activity
| | ==[[Sacroiliitis epidemiology and demographics|Epidemiology and Demographics]]== |
| * A traumatic injury or sudden impact, such as a motor vehicle accident or a fall, affecting your spine, lower back, pelvis or buttocks
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| * Spondyloarthropathies, which include [[ankylosing spondylitis]], [[arthritis]] associated with psoriasis and others
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| * Degenerative arthritis, also called [[osteoarthritis]] of the spine, causing degeneration of the [[sacroiliac joint]]s, which can cause mild [[inflammation]] and [[pain]]
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| * [[Pregnancy]], because the pelvis must stretch to accommodate childbirth
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| * Infection of the [[sacroiliac joint]], sometimes caused by bacteria in food ([[brucellosis]])
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| ==Diagnosis== | | ==[[Sacroiliitis risk factors|Risk Factors]]== |
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| === Clinical Features=== | | ==[[Sacroiliitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| * [[Pain]] and stiffness at lower back, thighs or buttocks, especially in the morning or when sitting for a long period of time
| | ==Diagnosis== |
| * [[Pain]] affecting hips and shoulders
| | [[Sacroiliitis history and symptoms|History and Symptoms]] | [[Sacroiliitis physical examination|Physical Examination]] | [[Sacroiliitis laboratory findings|Laboratory Findings]] | [[Sacroiliitis x ray|X Ray]] | [[Sacroiliitis CT|CT]] | [[Sacroiliitis MRI|MRI]] | [[Sacroiliitis other diagnostic studies|Other Diagnostic Studies]] |
| * [[Pain]] that worsens with walking because the swinging motion of hips strains [[sacroiliac joint]]s
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| * Inflammation in one or both of the eyes ([[uveitis]] or [[iritis]])
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| * [[Psoriasis]], an inflammatory skin condition
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| * Bloody [[diarrhea]]
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| * A low-grade [[fever]] that appears quickly
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| ===Physical Examination===
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| * Localized pain that seems to be on or around [[sacroiliac joint]]s, which can be determined by pressing on sacroiliac region while patient moves in certain ways to gently stress the [[sacroiliac joint]].
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| ===Laboratory Diagnosis===
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| * Cultures of fluid from the [[sacroiliac joint]]
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| * [[Blood culture]], if the cause appears to be an infection
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| * [[X-ray]]s of [[sacroiliac joint]]s
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| * [[Magnetic resonance imaging]] ([[MRI]]) scan of [[sacroiliac joint]]s
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| ===X-ray Findings in Differential Diagnosis===
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| *Normal SI joint is uniform in size throughout
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| :*Only lower 2/3 of SI joint are true joint
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| *Earliest sign of sacroiliitis is widening of the joint
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| :*Sclerosis and narrowing represent healing
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| *Unilateral Sacroiliitis
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| :*TB
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| *Bilateral and symmetric
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| :*[[Ankylosing spondylitis]]
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| :*:*Narrowing and sclerosis
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| :*:*Fusion eventually
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| :*:*Almost always bilateral
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| :*[[Inflammatory bowel disease]]
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| :*:*[[Ulcerative colitis]] more often then Crohn’s
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| *Enteropathic arthritis more common in Crohn’s-usually knee
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| :*:*Inflammatory bowel disease usually does not affect the spine as often as ankylosing spondylitis
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| :*:*Bilateral and asymmetric
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| :*[[Rheumatoid arthritis]], [[psoriasis]] and Reiter’s may affect one SI joint but usually affect both
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| :*:*Usually asymmetric
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| :*Gout is a rare cause of sacroiliitis
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| :*:*May see erosions in spine
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| *SI Disease in Crohn’s
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| :*About 3-16% of patient with Crohn’s
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| :*Occurs independent of activity of bowel disease
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| :*HLA B27 antigen is usually elevated
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| :*Bilateral SI joint narrowing and erosions with sclerosis
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| :*:*Identical appearance to AS
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| *SI Disease in Ulcerative Colitis
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| :*About 1-22% of patients with UC
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| :*Not correlated with activity of bowel disease
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| :*Spondylitis usually precedes onset of bowel findings
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| :*Appears identical to AS
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| :*More common in males
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| :*Peripheral joint involvement in 50-70%
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| :*:*Especially shoulders and hips
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| :*Higher incidence of elevated HLA B27 in patients with [[spondylitis]] or [[iritis]]
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| ==Differential Diagnosis of Causes of Sacroiliitis ==
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| * Bilateral & symmetrical
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| :* [[Ankylosing spondylitis]]
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| :* [[Reiter's syndrome]]
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| :* Enteropathic
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| * Bilateral & assymetrical
| | ==Treatment== |
| :* [[Psoriatic arthritis]]
| | [[Sacroiliitis medical therapy|Medical Therapy]] | [[Sacroiliitis surgery|Surgery]] | [[Sacroiliitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Sacroiliitis future or investigational therapies|Future or Investigational Therapies]] |
| :* [[Rheumatoid arthritis]]
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| :* [[Juvenile rheumatoid arthritis]]
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| * Unilateral
| | ==Case Studies== |
| :* [[Gout]] | | :[[Sacroiliitis case study one|Case #1]] |
| :* Infection
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| :* [[Osteoarthritis]]
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| [[Category:Rheumatology]] | | [[Category:Rheumatology]] |