EpistemisSacroiliac pain
Specialty: Musculoskeletal.
Why it occurs
- Inflammatory sacroiliitis in the spectrum of axial spondyloarthritis
- Mechanical dysfunction of the sacroiliac joint (overload due to pregnancy, childbirth or limb dysmetria)
- Pyogenic infection of the sacroiliac joint (infectious sacroiliitis, common in IV drug users or post-procedures)
- Osteoarthritis of the sacroiliac joint due to advanced age
- Overload secondary to previous lumbar spinal fusion
Initial workup
Magnetic resonance of sacroiliac joints with STIR sequences (early identifies active subchondral bone edema) | AP plain radiograph of the pelvis (classification of sacroiliitis according to modified New York criteria) | HLA-B27 | Quantitative CRP and ESR.
red flags
Exquisite unilateral pain in the buttock with high fever, chills, absolute inability to support the ipsilateral limb and a marked increase in acute phase reactants (suggests septic sacroiliitis, requires urgent drainage and antibiotic therapy).
Standard management
- Indomethacin — 75 mg extended release every 12 or 24 hours orally
- Certolizumab pegol — 200 mg subcutaneous biweekly; Biological anti-TNF therapy indicated in non-radiographic or refractory radiographic inflammatory sacroiliitis
- Ultrasound-guided sacroiliac infiltration of triamcinolone acetonide (40 mg combined with local anesthetic).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 5
- Treatment options
- 3