Sacroiliitis: Symptoms, Diagnosis, and Management Options

Sacroiliitis

Hello Dr.
Tseng, I have been experiencing symptoms for about three to four years now.
I have loved playing basketball since elementary school, and I still do.
I had grade II vesicoureteral reflux around the fourth grade, so I thought my lower back pain was due to sports injuries or that condition.
In 2015, my back suddenly became very sore, so I went to the Tri-Service General Hospital to see a urologist.
After waiting for a while for the report, I forgot to check it because the pain had subsided, so I didn’t go back to see the report.
Since then, I have had recurring soreness that comes and goes, which I thought was just sports-related.
Now that I have been in the military for almost six months, I have been experiencing severe soreness in my back and legs, especially as the weather has started to cool down.
At night, my legs alternate in soreness, and in the morning, I feel some stiffness in my body.
When I take my first step out of bed, it feels like my toe joints are being shocked for about two seconds.
I then went to the Tri-Service General Hospital to see a rheumatologist.
After explaining my symptoms, the doctor suggested it might be ankylosing spondylitis.
However, the X-ray results came back normal, and my blood tests were negative.
The doctor prescribed me some painkillers, but since the pain was severe, I took two at once, and it still hurt.
Later, I visited the rehabilitation department at the Tri-Service General Hospital, where the doctor performed a full-body CT scan and specifically enhanced the pelvic scan.
A week later, the report indicated that the doctor reviewed the images and diagnosed me with sacroiliitis, noting that my inflammatory markers were somewhat elevated.
The value was around 127, plus or minus three.
I asked if I could be discharged from service, but he told me to return to the rheumatologist for a decision.
Currently, I still have duties while in the military, and it is very painful to work through the back soreness.
I want to understand further why I have inflammation and what grade my sacroiliitis might be.
I am reaching my limit and want to request a discharge.
I am not sleeping well every day, and my routine is irregular.
I would like to ask for your opinion, doctor.

Zhou, 20~29 year old female. Ask Date: 2017/11/08

Dr. Zeng Guosen reply Internal Medicine

There are many reasons for back pain.
A CT scan shows sacroiliitis and elevated inflammatory markers, so it is recommended to consult a rheumatologist for differential diagnosis.
The physician should provide further recommendations.
Thank you for your question.

Reply Date: 2017/11/08

More Info

Sacroiliitis is an inflammatory condition affecting the sacroiliac joints, which connect the lower spine to the pelvis. This condition can lead to significant discomfort and pain, particularly in the lower back and buttocks, and may also radiate down the legs. Understanding the symptoms, diagnosis, and management options for sacroiliitis is crucial for effective treatment and improving quality of life.

Symptoms of Sacroiliitis
The symptoms of sacroiliitis can vary from person to person, but common signs include:
1. Pain in the Lower Back: This is often the most prominent symptom, typically localized to the lower back and buttocks. The pain may worsen with prolonged sitting or standing and may improve with movement.

2. Radiating Pain: Pain may radiate to the thighs or groin, and in some cases, it can extend down to the legs.

3. Stiffness: Many individuals experience stiffness in the lower back, especially in the morning or after periods of inactivity.

4. Difficulty with Movement: Activities such as bending, twisting, or climbing stairs may become painful.

5. Inflammation: There may be swelling or tenderness around the sacroiliac joint.

6. Fatigue: Chronic pain can lead to fatigue and a general feeling of malaise.

Diagnosis of Sacroiliitis
Diagnosing sacroiliitis typically involves a combination of clinical evaluation and imaging studies. Here are the steps usually taken:
1. Medical History: A thorough history of symptoms, including the onset, duration, and nature of the pain, is essential. Your history of playing basketball and any previous medical conditions, such as ureteral reflux, should be discussed.

2. Physical Examination: A healthcare provider will perform a physical exam to assess pain levels, range of motion, and any tenderness in the sacroiliac joint area.

3. Imaging Studies: X-rays may be performed to rule out other conditions. However, in many cases, MRI or CT scans are more effective in visualizing inflammation in the sacroiliac joints.

4. Blood Tests: Blood tests can help identify markers of inflammation and rule out other conditions, such as infections or autoimmune diseases.

Management Options for Sacroiliitis
Management of sacroiliitis often involves a multidisciplinary approach, including medication, physical therapy, and lifestyle modifications:
1. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation. In some cases, corticosteroids may be used for more severe inflammation.

2. Physical Therapy: A physical therapist can develop a tailored exercise program to improve flexibility, strengthen the muscles around the sacroiliac joint, and enhance overall mobility.

3. Injections: In some cases, corticosteroid injections into the sacroiliac joint may provide relief from pain and inflammation.

4. Lifestyle Modifications: Maintaining a healthy weight, engaging in low-impact exercises, and avoiding activities that exacerbate pain can be beneficial.

5. Alternative Therapies: Some individuals find relief through acupuncture, chiropractic care, or massage therapy.

6. Surgery: In rare cases where conservative treatments fail, surgical options may be considered, such as sacroiliac joint fusion.

Conclusion
Given your symptoms and the diagnosis of sacroiliitis, it is essential to work closely with a rheumatologist or a specialist in musculoskeletal disorders. They can help determine the underlying cause of your inflammation and tailor a treatment plan that addresses your specific needs. It’s also important to communicate openly about your pain levels and how they affect your daily life, especially in the context of your military service. If your symptoms continue to interfere significantly with your daily activities and sleep, discussing the possibility of a medical discharge with your commanding officer may be warranted.
Remember, managing chronic pain is a journey, and finding the right combination of treatments may take time. Stay proactive in seeking care and advocating for your health.

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