27.11.2020

Sacroiliitis

Sacroiliitis is a disease in which the inflammatory process is localized in the sacroiliac joint. This joint is sometimes called the joint, but this is not true. This so-called amphiarthrosis. This place connects the sacrum and the iliac bones by ligaments and this connection is very tight. This is due to the strongest ligaments in the human body – the sacroiliac ligaments.

Characteristically, right-handers more often the inflammation is on the right, this is because they have a hard right foot. And, accordingly, is exactly the opposite left-handers. A big burden accordingly falls on hard foot. Therefore, left-sided sacroiliitis occurs more often in left-handers, right-hand drive right-handers.

What is this disease sacroiliitis? It should immediately be noted that it is quite a serious condition that can lead to serious consequences. Namely, it can lead to the destruction of bones, cartilages, tendons, ligaments and even blood vessel walls.

Reasons

The causes of sacroiliitis can be a variety of diseases and conditions which can provoke an inflammatory process. Sacroiliitis can occur as an independent disease or be caused by other pathologies, infectious or autoimmune nature.

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Most often, this inflammation manifests as one-sided defeat. Bilateral sacroiliitis occurs in a rather complex disease that is caused by the brucellosis, tuberculosis, ankylosing spondylitis. Also symmetrical inflammation occurs due to autoimmune diseases.

Common cause of this disease is the disturbed biomechanics of the joint. That is, when the joints have an increased load. This occurs when a shortened limb. Also, the inflammatory process may occur in the injury. Most often this manifests itself when traumatized bone or ligaments. For example, the rupture of ligaments causing sacroiliitis.

Among the causes of sacroiliitis are the following factors:

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  • Osteoporosis. This condition affects women after menopause.
  • The congenital defects of the type, these include subluxations, dislocations, hip joint, and if the vertebrae of the sacrum is not fused.
  • The weakening of the pelvic ring, which is caused by a sedentary lifestyle, sedentary work.
  • Pregnancy. This situation occurs overload the structure.
  • Even sacroiliitis can occur because of tumors on the bones of the pelvis, as well as tumors in the pelvis and retroperitoneal space, the cysts.
  • Infections, such as syphilis, Lyme disease.

Bilateral sacroiliitis is often diagnosed in psoriasis, which is also complicated by arthritis. Arthritis is also another cause of sacroiliitis, and besides psoriatic, cause disease can rheumatoid, enteropeptidase and ankylosing spondylitis.

Sometimes even women are diagnosed with sacroiliitis after childbirth. This is evidenced by the testimonials of women and medical practice.

Classification and symptoms

Sacroiliitis klassificeret the nature of the inflammatory process:

  • Nonspecific type.
  • The specific type.
  • Aseptic type.
  • Non-infectious type.
Nonspecific sacroiliitis

Nonspecific type sacroiliitis is also called purulent, as there is inflammation due to osteomyelitis, breakthrough purulent lesions or infection occurs from an open injury. This lesion most often unilateral type. For this disease only manifests acute and pronounced symptoms. The patient’s condition is deteriorating very quickly.

The symptoms of sacroiliitis non-specific types:

  • The increased body temperature.
  • Pain sharp, localized lower abdominal and back.
  • In the body, thus there is a strong intoxication.

The complexity of the nonspecific type sacroiliitis is that the pus that gathered in the joint can invade nearby tissues.

Specific type

This species is rarely seen and is this disease chronic or subacute. Sacroiliitis is a specific type appears in tuberculosis, syphilis, brucellosis. This defeat can be as one-sided and two-sided.

Symptoms:

  • Pain in the pelvic region, but clearly localize the patients they can’t.
  • Stiffness of the joint.
  • In syphilis the pain is mostly at night.
  • The pain increases with physical activity, especially when turning and flexing of the spine.
Aseptic type

This variety of the disease called infectious-allergic sacroiliitis. It mostly occurs in rheumatic diseases. This is manifested Bechterew’s disease and in the diagnosis it is possible to identify inflammation of the joints at an early stage.

At the first stage of aseptic sacroiliitis be a characteristic diagnostic signs. This is the extended joint space, inexact contours of the joints. And the second stage will have to appear erosion.

Symptoms;

  • Pain in the buttocks, the pain experienced in the hip.
  • For Bekhterev’s disease characteristically, the pain subsides with movement and at rest again resumed.
  • Morning tightness.
Non-infectious sacroiliitis

In this case usually the Sacro-podvzdoshnaja joint affected by osteoarthritis or inflamed ligaments. These lesions do not always relate to sacroiliitis, but in medical practice in the diagnosis are diagnosed with sacroiliitis with an unclear etiology.

Causes of noninfectious sacroiliitis become different overload (e.g., pregnancy, professional sports, often carrying heavy loads), injuries. Also, this pathology can manifest itself with impaired posture, this case also occurs overload.

Symptoms:

  • Pain that is manifested by seizures and occurs spontaneously, without any stimuli. It is localized in the sacrum.
  • The increased pain, if the person long time does not change the body position (sitting, standing, tilted).
  • The pain may radiate to the lower back, hips, buttocks.
  • Scanost.
  • A person can develop a “duck walk”.
Other types

Still shares the disease sacroiliitis dependent on localization of the inflammatory process:

  • Synovitis is a condition in which the inflammatory process has spread only to the synovium, that is the inner layer of the joint.
  • Osteoarthritis is a condition in which inflammation partially touched the surface of the joint.
  • Partit – in this case the inflammation has already covered the entire joint, that is, all his fabric.

In the course of the disease it is divided into acute, subacute and relapsing course.

The stage of the disease

Sacroiliitis can occur in 4 stages. This separation of the disease is used by doctors when diagnosing, as the fastest and most basic method is x-ray.

The first stage already can be diagnosed using x-rays. Signs of sacroiliitis not very pronounced, but still visible: a marked blurring of the boundaries of the joint and the cracks.

In the second stage, it will be seen that the joint space is expanded unevenly. This condition is also called the symptom of “strings of pearls” or usource.

Stage 3 stage state of the joints is aggravated and begins to manifest ankylosis, that is, the joint space begins to close. Complete ankylosis has already been observed in 4 stages. This means that the joint space is closed completely and the sacroiliac joint podvzdoshnaja looks like a solid bone formation. In this case the nerve roots are compressed.

Diagnosis

Diagnosis of this disease starts with a physical examination of the patient by the doctor. Specialist presses on certain points, namely when sacroileitis they differ pain. First and foremost, patient is prescribed to pass x-ray examination, which is the most informative and quick in this case.

Doctors use such method of diagnosis: the patient should become healthy on the chair leg, and then on the chair to put the injured leg, then he must go down on the same principle – first healthy leg, then the patient. After such manipulation the patient will feel the pain clearly localized in the sacral-podvzdoshnaja joint.

Always be imposed even laboratory tests of blood and urine. Need biochemical, serological and immunological tests and PCR diagnostics.

To replace today, more effective diagnostic methods – CT or MRI.

Treatment

Treatment of sacroiliitis often treated by medication. Standard procedure the patient is prescribed nonsteroidal anti-inflammatory drugs, hormonal drugs, antibiotics. Additional drugs, each can be different according to individual characteristics of the organism.

If the patient has severe pain, he can assign the embargo. In the joint or in the trigger points of the muscles are injected a variety of drugs, sometimes even the introduction is carried out into the spinal canal. Such drugs include Lidocaine, Kenalog, Diprospan.

If a person has a specific kind of sacroiliitis, we used drugs that adversely affect the cause of the disease. For example, if you need a TB a Thioacetazone, Isoniazid.

Also effective for sacroiliitis there are various physiotherapy.

To physiotherapy include:

  1. Pulsed magnetotherapy.
  2. UHF.
  3. Phonophoresis combined with the use of anti-inflammatory drugs.
  4. Mud treatments.
  5. Paraffin baths.
  6. Laser therapy.
  7. Also, massage and physical therapy.

Physical therapy is mandatory for all patients, it helps to repair the joints and renew all metabolic processes. But apply physiotherapy, only after it has passed the acute phase of the disease.

Treatment of sacroiliitis with purulent lesions is different, because they require the use of antibacterial and detoxication therapy. Other medications prescribed by a doctor will focus on addressing the main symptoms. Purulent lesion that is localized in the joint, be sure to drain it or do it surgically, a meaningful operation. In particularly difficult cases can be shown even resection of the joint. Antibiotics are prescribed only after determining the sensitivity of the pathogen.

You also need to immobilize the joint. This is done using a special brace.

If in the anamnesis the patient has psoriatic arthritis, it is usually prescribed preparations of cytostatics – Methotrexate, and monoclonal antibody drugs – MabThera. To cure the affected joints you need to remove the root cause, which provokes it.

The symptoms and treatment of sacroiliitis differ dependent on the type of lesion. So the self is not to diagnose and especially to treat the disease. Sacroiliitis after treatment has a good prognosis, it is important that all took place under the supervision of a physician.

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