Sacroiliitis: inflammation of the sacroiliac joints

Other names: Сакроилеит, воспаление крестцово-подвздошного сустава, боль в крестце, боль в ягодице справа и слева, воспалительная боль в пояснице, сакроилеит на МРТ

Sacroiliitis is an inflammation of the sacroiliac joint, which connects the sacrum to the pelvic bones. These joints are almost immobile, but bear a large load, and their inflammation causes deep pain in the buttock and sacrum, radiating to the back of the thigh. A distinctive feature of inflammatory pain is that it is stronger at night and in the morning, accompanied by stiffness for more than half an hour and decreases with movement rather than at rest. Sacroiliitis is not an independent diagnosis, but a key symptom of a group of diseases, primarily axial spondyloarthritis. Less commonly, it is infectious or associated with pregnancy and trauma. Early diagnosis is important because modern treatment can stop progression.

🧾 МКБ-10: M46.1 🏥 Where it is treated: 6 Pain in the buttock and sacrumWorse at night, better from movementOften the onset of spondyloarthritis

👨‍⚕️ Which doctor

Rheumatologist, therapist, vertebrologist

🔬 Diagnostics

MRI of the sacroiliac joints, pelvic X-ray, ESR, C-reactive protein, HLA-B27

💊 Treatment

Physical therapy, anti-inflammatory drugs, basic and genetic engineering therapy according to indications

📈 Prognosis

Chronic course; early treatment and exercise maintain mobility

⚠️ At risk

Young age, HLA-B27 carriage, psoriasis, inflammatory bowel disease, previous intestinal and urogenital infections

⏱ When to see a doctor

Planned; for fever - urgent

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Высокая температура с ознобом и резкой болью в крестце — возможен гнойный процесс
Невозможность наступить на ногу, покраснение и отёк над суставом
Боль после травмы таза
Быстрая потеря веса, ночная потливость
Слабость в ногах, онемение промежности, нарушение мочеиспускания
Боль на фоне сниженного иммунитета или после операции

Causes and types

Most often, sacroiliitis is a manifestation of axial spondyloarthritis, a chronic autoinflammatory disease that affects the spine and sacroiliac joints mainly in young people. This group also includes arthritis due to psoriasis, Crohn's disease and ulcerative colitis, as well as reactive arthritis after an intestinal or urogenital infection. Separately, there are infectious sacroiliitis, including tuberculosis, and non-inflammatory causes - overload, trauma, pregnancy, when the biomechanics of the pelvis changes.

Axial spondylitis, including ankylosing spondylitis
Psoriatic arthritis
Arthritis in Crohn's disease and ulcerative colitis
Reactive arthritis after infection
Infectious, including tuberculous sacroiliitis
Trauma and joint overload
Changes during pregnancy and after childbirth

How to distinguish inflammatory pain from normal pain

Mechanical back pain occurs after exercise and subsides with rest. Inflammatory pain behaves in the opposite way: it appears gradually in a person under 40–45 years of age, lasts more than three months, awakens in the second half of the night, is accompanied by morning stiffness for more than 30 minutes and decreases with warm-up and physical activity. The pain is often intermittent in the buttocks, sometimes on the right, sometimes on the left. Associated symptoms also help to suspect the disease: inflammation of the eye, psoriasis, heel pain, diarrhea mixed with blood.

Onset at a young age, gradual
Duration more than three months
Nocturnal pain in the second half of the night
Morning stiffness for more than 30 minutes
Better by movement, worse by rest
Intermittent pain in the buttocks
Good response to anti-inflammatory drugs

Associated manifestations

Spondyloarthritis affects not only the spine. In some people, the choroid of the eye becomes inflamed: pain, redness, photophobia and blurred vision appear, and this requires an urgent examination by an ophthalmologist. Often there is pain in the places where the tendons attach - in the heels, Achilles tendon, ribs. Possible swelling of one large joint of the leg, “sausage-shaped” toe, skin plaques of psoriasis, chronic diarrhea. Common symptoms are fatigue, low-grade fever, decreased performance.

Pain and redness of the eye, photophobia
Heel and Achilles tendon pain
Swelling of the knee or ankle joint
Swelling of the entire finger or toe
Psoriatic plaques on the skin
Chronic diarrhea, blood in stool
Fatigue and low-grade fever

Diagnostics

An X-ray of the pelvis shows changes in the sacroiliac joints, but they appear years after the onset of the disease. Therefore, if early spondyloarthritis is suspected, MRI has become the main method: it detects bone marrow edema - a sign of active inflammation - long before radiological changes. Laboratory assessment of ESR and C-reactive protein, and also determination of HLA-B27 carriage; It is important to understand that this marker is also found in healthy people and does not make a diagnosis in itself. If an infection is suspected, a different set of tests is needed.

Examination by a rheumatologist with tests for the sacroiliac joints
MRI of the sacroiliac joints
X-ray of the pelvic bones
ESR and C-reactive protein
HLA-B27 as an auxiliary marker
General blood test
If an infection is suspected, test for tuberculosis and cultures

Treatment

The basis of treatment for inflammatory sacroiliitis is daily physical therapy for stretching and mobility of the spine and chest, breathing exercises; without them, no therapy preserves posture. The doctor prescribes non-steroidal anti-inflammatory drugs, which work especially well for spondyloarthritis, and if the effect is insufficient, he uses basic or genetically engineered biological drugs that affect the mechanism of inflammation. Local injections of glucocorticoids into the joint are used according to indications. Infectious sacroiliitis is treated with antibiotics based on the results of the examination. Smoking worsens the course of the disease, quitting it is part of the treatment.

Daily spinal mobility exercises
Swimming and breathing exercises
Non-steroidal anti-inflammatory drugs as prescribed by a doctor
Genetic engineering biological therapy with high activity
Local injections according to indications
Antibacterial therapy for infectious diseases
Smoking cessation, weight control
Regular observation by a rheumatologist

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

🔬 Diagnostics

Консультация терапевта первичнаяfrom 150 000 Рентген костей таза (прямая проекция)from 200 000 МРТ пояснично-крестцового отдела позвоночника С-реактивный белок (количественный)from 110 000 СОЭ (скорость оседания эритроцитов)from 30 000

Frequently asked questions: Sacroiliitis

How to understand that back pain is inflammatory?+

It begins gradually at a young age, lasts more than three months, awakens in the second half of the night, is accompanied by morning stiffness for more than 30 minutes and decreases with movement. Mechanical pain, on the contrary, increases with stress and goes away with rest.

What does positive HLA-B27 mean?+

This is just a marker of predisposition. It also occurs in healthy people, so it does not confirm the diagnosis in itself. The combination of a positive result with typical inflammatory pain and changes on MRI is important.

Why is the x-ray normal, but there is pain?+

X-ray changes in the sacroiliac joints appear only years after the onset of the disease. Active inflammation at an early stage is visible only on MRI, so if spondyloarthritis is suspected, it is prescribed.

Is it possible to cure sacroiliitis completely?+

Infectious and post-traumatic are cured after the cause is eliminated. Sacroiliitis in spondyloarthritis is a chronic condition, but modern therapy and daily exercise can suppress inflammation, maintain mobility and live an active life.

Does heating and massage help?+

Warmth and gentle massage can relieve muscle tension but do not affect inflammation. The basis is exercise and drug therapy. If infection is suspected, heating is contraindicated.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.