Sacroiliitis

[hayley3]

Hello,
I had a CT scan done when I was 33 yrs old and was told that I had osteoarthritis of the sacroiliac and spine with generalized osteoporosis.  I now have a diagnosis of probable reactive arthritis with axial involvement 13 years later.

My question is about the CT scan.  Could this be sacroiliitis rather than osteoarthritis:

Findings:
There is mild periarticular sclerosis in both SI joints associated with mild SI joint narrowing.  Definite bony erosions are not identified.  There is mild to moderate generalized bony demineralization.

Impression:
Mild degenerative change and bony demineralization

This scan was taken 7 years after I had been hospitalized for a bout of cystitis/PID/cervicitis/salpingitis.

Do they base the diagnosis of sacroiliitis on the clinical symptoms and the CT scan, or is it just based on the CT scan?
I feel that the erosions were already gone when they did the CT scan, because it had been 7 years since the low back pain started, and that's why they didn't diagnose sacroiliitis.  
Any insight appreciated!

Thank you so much!

[Kevin Pho, MD]

Hello - thanks for asking your question.

The diagnosis of sacroiliitis is based on both the physical exam and X-ray studies.  Conditions that can predispose patients to sacroiliitis include trauma, pregnancy, infections of the skin, osteomyelitis, urinary tract infection, endocarditis and drug addition.

Fever, pain, and decreased range of motion in the sacroiliac joint are the most common symptoms.  Sometimes the sacroiliac joint pain can be mistakenly attributed to another source, such as septic hip, psoas abscess, malignancy, sciatica, herniated disc, pyelonephritis, ankylosing spondylitis or appendicitis.

Characteristic radiographic features include joint space narrowing, sclerosis, and erosions of the ilium and sacrum.

Sacroiliitis is associated with a variety of diseases include ankylosing spondylitis, inflammatory bowel disease, or other rheumatological diseases such as lupus.  

So to answer your question, it is possible it can be sacroiliitis - I cannot be more specific without examining you.  If there is one of these other disorders (above) present, it would make sacroiliitis is more likely.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Lizebeth32]

Please allow me to comment on this.  Last Oct. my 2 yr. old daughter became very ill.  To make a long story short, it took us a while before we could find out what was wrong with her. She had severe pain in her right leg.  I mean severe.  She stopped walking and she could not even sit up.All she did was cry. She was running fever also.  They thought she has septic hip.  She was in the hospital for a week.  Had 2 MRI both neg.  However blood test showed Bacterial infection.  She was on Augmentin for 11 days.  Pain got better.  After 2 wks she still could not walk or sit up.  they did more xrays and blood test which now showed her platelet count was sky high and her WBC was higher than it had ever been.  They sent her to another hospital.  After looking at the test that had already been run they thought she has cancer.  We had to go through all the cancer screenings.  We were lucky she did not have cancer.  We were no closer to finding out what was wrong.  The PED. Radiologist suggested getting a bone scan.  Wouldn't ya know it there it was .  SACROLITIIS.    They had to research this. We were at a very big hospital with a huge pediatric dept. We were told they had never seen a case of this at the hospital. They found out that there is only 177 cases diagnosed in the WHOLE WORLD. She is a 178.  She ended up being on 6 wks of IV antibitics.  She was in the hospital for another week and they sent her home with a pick line in her left arm and home health helped us with the IV antibiotics. They told us had she not gotten the 11 days of augmentin things would have been very diffent.  The augmentin took some of the infection away but it was not strong enough to get into the joint. There is a lot more to this story.  A lot more including an incopetent doctor that sent her home the first time she showed symptoms.  He even told us to ignore it there was nothing wrong with her.

[Lizebeth32]

Hi,  I did fail to mention that my 2 year old daughter had been down for 2 mths.  We did have to teach er to walk all over again.  It took her awhile to get the use of her legs back but with physical therapy and a pediatric walker she did.

[georgirl2003]

Hi, I have fibromyalgia, undifferentiated connective tissue disease and last week I went to the Dr. with a mid urinary tract infection to with he put me on Cipro for 5 days. Later I got a  note from the office saying the test was negative, but the symptoms did go away. That was on a monday. By Friday I began to feel not right, week, hard to walk up stairs and within a few hours when I when to meet my husband at the mal I could hardly get out of the car, my hip hurt so bad.  It progressively got worse all weekend.  I went to the Dr. on Monday and he said it was sacroilitis.  He changed some of my meds so I would still have my pain pills, but would also have more anti-inflamatory meds.  My concern is that from reading what others have written in here it sounds like it's an infection.  I'm confused.

[marathonr]

Hi. I have been diagnosed with sacroiliitus. Not that I am questioning the diagnosis but here are some details...I am an avid runner. After a run one day 3 years ago, I had severe pain in my lower back/upper butt. To make a long story short, I was basically paralyzed with pain (and I have a very high tolerance for pain). I was sent by ambulance to the ER where they had no clue what was wrong. I eventually made it to my internal medicine doc who diagnosed me first. After weeks of physical therapy, I was able to walk and slowly run again. I then had a bone scan (now seeing a rheumatologist) which was inconclusive and it was said that I either had a degenerative joint or a stress fracture. I've been taking vioxx for over 2 years and the pain is basically managed. However, I've seen three different ortho docs (who did nothing for me) and am now seeing my rheumatologist (who is wonderful) but is vioxx the long-term answer for me? Any thoughts would be appreciated.