Sacroiliitis is an inflammation of the sacroiliac joint. A patient with this disorder can present in a variety of different ways. Often a patient with sacroiliitis will come to their physician with a sudden onset of fever, pain and decreased range of motion. Non-acute patients may or may not present with a fever. Patients are often ill, limping, in pain and showing a decreased range of motion, but the symptoms are still generally vague. All patients with sacroiliitis will have sacroiliac joint pain, but this symptom can be overlooked because of the patient's refusal to move due to their pain.
The sacroiliac joint is encompassed in a large amount of ligamentous and fibrous tissue for added stability. Conditions that can predispose patients to sacroiliitis include trauma, pregnancy, infections of the skin, osteomyelitis, urinary tract infection, endocarditis and drug addiction. This type of infection is seen with some frequency in intravenous drug users.
In the physical examination, 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. Subacute sacroiliitis is hard to diagnose and the delay in proper diagnosis and treatment can lead to increased joint destruction, potential rupture, abscess formation and morbidity.
A clinical, physical and laboratory evaluation is critical for an accurate and early diagnosis of sacroiliitis. In the physical examination it is important for the physician to localize the pain and decreased motion. In most cases a blood culture can make the diagnosis. The exception to that rule is intravenous drug users who have self medicated themselves with an antibiotic, masking an accurate blood culture. An open biopsy and culture may be required to establish an accurate diagnosis and to identify the correct infectious agent.
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