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sacroiliitis

Inflammation of the sacroiliac joint. Etiology: 1) ankylosing spondylitis & other spondyloarthropathies - inflammatory bowel disease: Crohn's disease, ulcerative colitis 2) reactive arthritis 3) familial Mediterranean fever [3] 4) granulomatous disease: tuberculosis [4], sarcoidosis [5] 5) trauma: unidirectional shear forces such as stepping off a curb [1] 6) idiopathic Epidemiology: - up to 15% of low back pain [6] Clinical manifestations: 1) low back pain & stiffness 2) with or without tenderness over the sacroiliac joints 3) may be asymptomatic 4) poorly localized buttocks pain, & inability to bear weight - pain may be localized to the dimple areas on the buttocks [1] 5) involvement may initially be unilateral, but invariably becomes bilateral 6) referred pain to the groin or thigh may be present [6] 7) positive FABER test, Patrick's test & Gaenslen's test 8) no pain with passive range of motion of the hips Laboratory: - HLA-B27 in blood (prior to MRI of sacroiliac joint) Radiology: 1) radiographic changes generally more prominent on the ilial side of the joint a) periarticular arthritis b) loss of definition of joint line c) pseudowidening of the joint d) later changes 1] eburnation of surrounding bone 2] sclerosis progressing to ankylosis 2) radionuclide techniques may show early changes, but are relatively non-specific 3) magnetic resonance imaging (MRI) a) indicated when plain radiographs are negative & index of suspicion is high b) shows increased T2-weighted signal from bone & bone marrow suggesting edema Complications: - progression to ankylosing spondylitis [7] Differential diagnosis: - sciatica Management: 1) treatment of specific etiology 2) rest 3) non-steroidal anti-inflammatory drugs (NSAIDs) 4) consider physical therapy 5) glucocorticoid injection for patients not responding to conservative therapy [1]

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sacroiliac joint

General

sign/symptom inflammation sacroliac disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2021
  2. UpToDate 13.3 http://www.utdol.com
  3. Balaban B et al Sacroilitis in familial Mediterranean fever and seronegative spondyloarthopathy: importance of differential diagnosis. Rheumatol Int 2005; 25:641 PMID: 15711787
  4. Papagelopoulos PJ et al, Tuberculous sacroiliitis: A case report and review of the literature. Eur Spin 2005;14:683 PMID: 15690213
  5. Erb N et al, An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis Chest 2005; 127:192 PMID: 15653983
  6. Internal Medicine News, April 1, 2008
  7. Wang R et al. Progression of nonradiographic axial spondyloarthritis to ankylosing spondylitis: A population-based cohort study. Arthritis Rheumatol 2016 Jun; 68:1415
  8. 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: 30045603 Free article.
  9. NEJM Knowledge+ - Wordsworth P. Arthritis and inflammatory bowel disease. Curr Rheumatol Rep. 2000 Apr;2(2):87-8. PMID: 11123044 No abstract available. - Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol. 1988 Jul;83(7):703-9. PMID: 3289378 Review.