Sacroiliitis - Causes, symptoms and treatment. MF.

Sacroiliitis is an inflammation of the sacroiliac joint. The inflammatory process can extend to the synovial membrane( synovitis), affect the joint surfaces( osteoarthritis) or the entire joint( panartrite).Distinguish aseptic( infectious-allergic), specific( for example, with tuberculosis) and nonspecific( purulent) sakroileitis. Aseptic sacroileitis - see Arthritis, Ankylosing spondylitis;specific sakroileitis - see Brucellosis, extrapulmonary tuberculosis, bones and joints.

Symptoms of sakroileitis

Acute purulent sakroileitis begins with an increase in body temperature, chills. Acute suppurative sakroileitis can occur with osteomyelitis, a breakthrough of a purulent focus from the bone, or due to direct infection during open trauma. More often it is one-sided and is characterized by a rapid current with a high fever, pains in the lower abdomen on the side of the pelvic lesion. With it often there are purulent fouling.

Rapidly developing severe intoxication, leukocytosis, an increase in ESR is detected in the blood. Locally there are sharp pains in the area of ​​the sacroiliac joint, which increase with palpation, pressing on the wings of the iliac bones and re-flexion of the lower limb. The patient takes a forced position with bent legs. Early diagnosis is difficult if local clinical manifestations are poorly expressed. In children, sacroiliitis is often regarded as an acute infectious disease. Radiographically, with purulent inflammation of the sacroiliac joint, affecting only the synovial membrane, there is an enlargement of the joint gap and a mild osteoporosis of the articular parts of the sacrum and iliac bone. In osteoarthritis, the articular gap, on the contrary, is narrowed, the contours of articular surfaces are uneven, blurred.

With subacute flow of purulent sacroiliitis , the onset of the disease is erased. Subfebrile body temperature, uneven increase in ESR, moderate local soreness in the sacroiliac joint area are noted. The physical activity of patients is reduced a little. X-ray changes are detected sometimes after 2-3 weeks.

Often, is sacroileit has a chronic course with frequent exacerbations of .Chronic sakroileitis are more often acute and are mainly of tuberculous and brucellosis etiology. The latter are often two-sided. Chronic sakroileitis is manifested by pains similar to pain in sciatica, making walking difficult and long standing. In the study of the patient, pains in the sacroiliac joint are observed in the compression and extension of the pelvic wings, with maximum flexion of the hip and shin on the side of the lesion and straightened the other leg, in the finger examination of the rectum with pressure on the articulation area. Tuberculosis sacroiliitis sometimes gives a scar on the back of the thigh.

Diagnosis of chronic sacroiliitis is based on clinical data and X-ray examination, which reveals signs of sacroiliac joint damage. X-ray picture is diverse: partial or complete destruction of articular surfaces with the disappearance of the joint gap, foci of osteoporosis, destruction and sclerosis of periarticular bone tissue, sequestration of various sizes. With brucellosis sakroileitis, a positive serological response to brucellosis helps diagnosis.

Complications of sakroileitis

A severe complication of purulent sacroileitis is the formation of purulent swelling with a breakthrough into the gluteal region and, especially, into the pelvic cavity. In the presence of swollen palpation and rectal examination, a painful fluctuating elastic formation is revealed. The penetration of pus into the sacral orifice and the vertebral canal is accompanied by a lesion of the spinal cord and its membranes.

Treatment of sakroileitis

Patients with purulent sacroileitis need to be hospitalized. Treatment is aimed at eliminating purulent inflammation and increasing the resistance of the body. In purulent osteoarthritis, panarthritis, as well as in chronic forms of purulent sacroileitis, resection of the sacroiliac joint with dissection and drainage of purulent foulings is indicated, and if necessary, revision of the sacral orifices and sacral canal. The prognosis for life is usually favorable.

Treatment for acute sakroileitis: antibiotics( penicillin, streptomycin, etc. intramuscularly), with pus accumulation - opening and draining of the purulent cavity.

Treatment of chronic sakroileitis is basically conservative - specific antibacterial therapy( see Brucellosis, Tuberculosis of bones and joints);with tuberculous sakroileitis - immobilization with plaster beds, in some cases surgical treatment with resection of the sacroiliac joint.

Aseptic sacroileitis occurs chronically according to the type of arthrosis and most often accompanies various deformities of the pelvis, lower extremities, spine, is constantly found in ankylosing spondylitis. Treatment of aseptic sakroileitis - elimination of the cause of the disease and physiotherapy.