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Chronic inflammation of the sacroiliac joint
In medicine, chronic inflammation of the sacroiliac joint is called sacroiliitis. The joint is located in the lower section of the spine between the ilium and the sacrum. Sacroiliitis occurs very rarely as an independent disease. In most cases, it is the result of other diseases such as Bechterew's disease, Reiter's disease or Crohn's disease. Here is a brief summary:
- definition: Sacroiliitis is a chronic inflammation of the sacroiliac joint, which in most cases occurs as a result of certain diseases.
- Symptoms: Back pain, severe pain in the cross, which sometimes radiates into the buttocks or groin, restricted movement, postural damage.
- causes: Often sacroiliitis is a consequence of Bechterew's disease, Reiter's disease or Crohn's disease. The exact causes are still unclear.
- treatment: Physiotherapy, pain therapy, anti-inflammatory and pain-relieving medication, in serious cases, an implant is used surgically.
The sacroiliac joint
The sacroiliac joints have a shape like a boomerang and only a range of motion of 5 to 7 degrees. In many people, the joint stiffens with advanced age and has only a minimal degree of mobility. The joint sits between the sacrum, the penultimate end of the spine, and the ilium, which forms the pelvic blades.
The load on the sacroiliac joint
The joints between the two pelvic bones and the sacrum have to bear a large load. At this point, the pressure from below generated by the legs and the load from the upper body are compensated. This creates a great burden on the region. If this joint is inflamed, it can cause considerable pain and other unpleasant consequences.
Course of the disease
The course of sacroiliitis is usually long and worsens over the course of the disease. There is severe lumbar vertebral pain that radiates up to the buttocks or groin (groin pain). In addition, there are often restricted movement and poor posture.
Is sacroiliitis curable?
The disease is medically classified as chronic progressive inflammation. This means that a complete cure is not possible. The severity of the disease tends to increase. Constant and consistent treatment, especially through physiotherapy, mitigates the effects and enables a higher quality of life.
The exact causes are considered to be insufficiently understood. Experts suspect that a genetic predisposition triggers this suffering. Sacroiliitis is very rare on its own, but often occurs as a result of certain diseases. These include, for example:
- Ankylosing spondylitis,
- Reiter's disease (reactive arthritis),
- Behçet's disease,
- Psoriatic arthritis, a specific type of psoriasis
- inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.
Typical symptoms of sacroiliac joint inflammation include:
- Low back pain and buttocks pain, which is often more intense at night or in the morning than during the day,
- pain radiating to the groin or legs,
- Restricted movement in the cross,
- stiff legs,
- Pain when sitting,
- Problems walking, standing for long periods and climbing stairs.
Doctors often use the following methods to diagnose this disease:
- Medical history (patient's medical history),
- extensive physical examinations,
- "Chair climb attempt" or similar tests,
- imaging techniques.
Attempt to climb chair
If sacroiliitis is suspected, doctors often use the "chair climbing attempt". Those affected try to climb onto a chair with one leg. This movement triggers the typical symptoms of the disease.
Inflammation at the sacroiliac joint can be visualized by imaging procedures on the lumbar spine and pelvis. In addition, other diseases can be excluded from the recordings. For this reason, methods such as X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) are often used for diagnosis. While X-rays show that sacroiliitis is only in an advanced state, an MRI scan enables a much earlier diagnosis.
The type of treatment depends on the severity of the disease. In most cases, physiotherapy measures are taken in the early stages, which are supported by applications of heat, cold or electrotherapy. Anti-inflammatory and analgesic drugs are also often used. If these measures reach their limits, there is the option of surgically inserting a titanium implant that supports the sacroiliac joint.
As an early measure, attempts are often made to alleviate the pain through regular physiotherapy and to improve or maintain mobility. Some of the exercises you have learned can then be carried out at home. The use of heat, cold or electrotherapy can support this process. In acute phases, however, heat treatment should be avoided, since this worsens the symptoms in the acute state.
With sacroiliitis, pain relieving and anti-inflammatory drugs are often prescribed. Non-steroidal anti-inflammatory drugs (NSAIDs), for example, are suitable as anti-inflammatories. Ibuprofen or diclofenac are often used to relieve pain. However, care should be taken that the painkillers are only taken in phases and not permanently. If the pain is particularly severe, a pain reliever is injected directly into the sacroiliac joint.
Another aspect of the treatment is relief from severe pain. In addition to taking painkillers, additional methods can be used. This includes, for example:
- High frequency therapy,
- autogenic training,
- progressive muscle relaxation.
If all other methods do not achieve the desired results, it is possible to stabilize the sacroiliac joint with an implant. The triangular titanium implant is inserted into the sacroiliac joint in a minimally invasive operation to support it from now on. (tf, vb)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek, Barbara Schindewolf-Lensch
- German Society for Rheumatology (DGRh): S3 guideline for axial spondyloarthritis including ankylosing spondylitis and early forms, as of November 2013, detailed view of guidelines
- German Association of Bechterew's Disease: clinical picture and symptoms (accessed: July 16, 2019), bechterew.de
- Merck and Co. Inc .:. Bechterew's disease (accessed: July 16, 2019), msdmanuals.com
- Amboss GmbH: Reactive Arthritis (Reiter's disease) (access: July 16, 2019), amboss.com
- Deutsche Rheuma-Liga Bundesverband e.V .: Reactive Arthritis (accessed: July 16, 2019), rheuma-liga.de
- Professional association of German internists e.V .: Crohn's disease causes and risk factors (accessed: 16.07.2019), internisten-im-netz.de
- Professional Association of Pediatricians e. V .: Crohn's disease (accessed: 16.07.2019), kinderaerzte-im-netz.de
- Mayo Clinic: Sacroiliitis (access: July 16, 2019), mayoclinic.org
ICD codes for this disease: M46ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.