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The pain associated with sacroiliitis most commonly occurs in the buttocks and lower back. It can also affect the legs, groin and even the feet. Sacroiliitis pain can be aggravated by:

• Prolonged standing
• Bearing weight more on one leg than the other
• Stair climbing
• Running
• Large strides
• Extreme postures

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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A wide range of factors or events may cause sacroiliac joint dysfunction, including:

• Traumatic injury. A sudden impact, such as a motor vehicle accident or a fall, can damage your sacroiliac joints.
• Arthritis. Wear-and-tear arthritis (osteoarthritis) can occur in sacroiliac joints, as can ankylosing spondylitis — a type of inflammatory arthritis that affects the spine.
• Pregnancy. The sacroiliac joints must loosen and stretch to accommodate childbirth. The added weight and altered gait during pregnancy can cause additional stress on these joints and can lead to abnormal wear.
• Infection. In rare cases, the sacroiliac joint can become infected.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Depending on the severity of the pain, sacroiliitis can make it difficult for you to:

• Sit
• Stand
• Walk
• Sleep
• Bend

Sacroiliitis may be part of an inflammatory arthritic condition known as ankylosing spondylitis. Complications of this condition can be very serious, including difficulty breathing, spine deformities, lung infections and heart problems.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You're likely to start by first seeing your family doctor or general practitioner. However, because sacroiliitis can be difficult to diagnose, you may be referred to a rheumatologist or an orthopedic surgeon.

What you can do
Before your appointment, you may want to write a list that answers the following questions:

• When did your symptoms start?
• Where exactly does the pain occur?
• Does any type of activity worsen or lessen the pain?
• Can you think of anything that may have triggered the pain, such as a car accident or a recent fall?
• What medications and supplements do you take?

What to expect from your doctor
During the physical exam, your doctor may try to pinpoint the cause of your pain by pressing directly on various places on your hips and buttocks. He or she may also move your legs into a variety of positions that will gently stress your sacroiliac joints.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

The following factors may increase your likelihood of getting the condition:

• A history of bone, joint or skin infections. Some people are more prone to infections, and an infection is one possible cause of sacroiliitis.
• Injury or trauma to your spine, pelvis or buttocks. Torn ligaments or trauma may create inflammation or infection of the sacroiliac joints.
• Urinary tract infection. This infection may spread from your urinary tract, which includes your kidneys, bladder and urethra, to your sacroiliac joints.
• Pregnancy. The pelvic bone's expansion to prepare for childbirth may inflame the area around your sacroiliac joints.
• Endocarditis. This infection of your heart's inner lining may spread to your sacroiliac joints.
• Illicit drug use. People who inject drugs may have a higher risk of developing sacroiliitis.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Imaging tests

• X-rays. Plain X-rays can reveal signs of damage to the sacroiliac joint.
• Computerized tomography (CT scan). CT scans combine X-ray images taken from many different angles to create cross-sectional images of internal structures.
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, MRI machines produce very detailed cross-sectional images of both bone and soft tissues.

Lab tests
If your doctor suspects that you have an infection in your sacroiliac joint, he or she may want to run tests on a sample of fluid from within that joint. The sample is obtained with a needle. Because the sacroiliac joint is located so deep within the body, the doctor may use ultrasound or another imaging technique to ensure that the needle is placed correctly.

Anesthetic injections
Because low back pain can be caused by so many different types of problems, your doctor may suggest using injections of anesthesia to help pinpoint the diagnosis. For example, if an injection of numbing medicine into your sacroiliac joint stops your pain, it's likely that the problem is in your sacroiliac joint. However, the numbing medicine can leak into nearby structures, and that can reduce the reliability of this test.

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The type of treatment your doctor will recommend depends on the signs and symptoms you're having, as well as the underlying cause of your sacroiliitis.

Medications

• Pain relievers. If over-the-counter pain medications don't provide enough relief, your doctor may prescribe a non-narcotic pain reliever, such as tramadol (Ultram). Occasionally, a short course of narcotics may be prescribed. These drugs are habit-forming and shouldn't be used for long periods of time.
• Muscle relaxants. Medications such as cyclobenzaprine (Flexeril) may help reduce the muscle spasms often associated with sacroiliitis.
• Corticosteroids. Drugs such as betamethasone (Celestone) or triamcinolone (Kenalog) can be injected into the joint to reduce inflammation and pain. But you can receive only a few joint injections a year because the steroids can weaken your joint's bones and tendons.
• Disease-modifying antirheumatic drugs (DMARDs). If your sacroiliitis is caused by ankylosing spondylitis, you may be helped by drugs such as sulfasalazine (Azulfidine) and methotrexate.
• TNF inhibitors. Tumor necrosis factor (TNF) inhibitors — such as etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) — often help relieve the type of sacroiliitis that's associated with ankylosing spondylitis.

Therapy
Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to maintain joint flexibility, and strengthening exercises to give your muscles additional stability.

Surgical and other procedures
If other methods haven't relieved your pain, you doctor might suggest:

• Radiofrequency denervation. Radiofrequency energy can damage or destroy the nerve tissue causing your pain.
• Electrical stimulation. Implanting an electrical stimulator into the sacrum may help reduce pain caused by sacroiliitis.
• Joint fusion. Although surgery is rarely used to treat sacroiliitis, fusing the two bones together with metal hardware can sometimes relieve sacroiliitis pain.

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• Over-the-counter pain relievers. Drugs such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) may help relieve pain associated with sacroiliitis. Some of these drugs can cause stomach upset, or kidney or liver problems.
• Rest. Modifying or avoiding the types of activities that aggravate your pain may help reduce the inflammation in your sacroiliac joints. Proper posture is important.
• Ice and heat. Alternating ice and heat may help relieve sacroiliac pain.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.