Sacroiliac joint pathologies in low back pain

Abstract

The study describes the clinical spectrum of patients with low back pain due to sacroiliac joint (SIJ) involvement with the proposition of a diagnostic scheme. In this retrospective review, 61 patients with SIJ pain (unilateral or bilateral) greater than six weeks duration were evaluated by pain history, clinical examination including SIJ provocative tests, laboratory investigations and skeletal imaging. Fifty two patients (M: F, 31:21) were diagnosed to have specific SIJ pathologies amongst 61 patients presenting between 2002 to 2004. Forty patients (65%) were diagnosed with rheumatic conditions - ankylosing spondylitis (AS) - 21, undifferentiated spondyloarthropathy (UspA) - 11, psoriatic arthropathy (PS) - 5, reactive arthropathy (ReA) - 1 and juvenile spondyloarthropathy (JS)-2. Non rheumatic conditions were involved in 12 patients (20%) - osteitis condensus ilii (OCI) - 4, osteomalacia - 2, tuberculosis - 2, pyogenic arthritis - 1, pregnancy related sacroiliac joint pain - 2 and malignancy in 1 patient. The diagnosis could not be confirmed in 9 patients (15%). Medical history, clinical examination including SIJ tests, plain radiography and laboratory investigations were helpful in diagnosing SIJ pathology in 39% cases (n = 24), 46% (n = 28) needed CT or MRI. A diagnostic scheme of dividing the SIJ pathologies into rheumatic and non-rheumatic conditions was helpful in evaluating patients with suspected SIJ pathologies.