Severe SI Joint and Lower Back Pain: Possible Sacroiliitis worsen after conventional treatment.

Patient

Q: I have two issues, which may or may not be related. First, I started having pain on the very tip of my tailbone, about 3 yrs ago. Mostly while sitting. Had X-Ray, CT and MRI when pain became persistent in Spring 2011. GP referred me to pain clinic. The DR twas convinced my pain was caused by SI joint area. He pressed on both hip joints and since then I have had pain in both hips, buttock area and some down the back side of both legs, better when standing. Went through a Medrol Dose Pack. Then series of 3 cortisone injections directly into the SI joint. It helped a little bit, but did not take care of the pain. The pain is now as bad as ever. The same doctor wants to do two oblation procedures to kill the nerve. I am not convinced this is, or will solve, the problem. Another issue... Last Winter, I started having severe coldness and what I assume is arthritic type pain, in both lower legs. Cannot keep them warm!! Sincerely.

Doctor

A:    Sacroiliitis is the inflammation of the Sacro-Iliac bone, located in the lower part of the spine, in the back of the pelvis, just above of the coccyx or tailbone. The inflammation may be caused by diverse factors as: falling, car accidents, blows directly or to the side of the pelvis, or degenerative arthritis. In an individual with persistent sacroiliac pain, the differential diagnoses to be considered are: Hip overuse Syndrome, Iliotibial band Syndrome, Lumbosacral facet Syndrome, Piriformis Syndrome, Trochanteric bursitis, Lumbosacral radiculopathy, Sacroiliac joint infection, Seronegative spondyloarthropathy, Reiter Syndrome. Some studies show that sacroiliac pain would appear to be at least 13% and perhaps as high a 30% in patients with low back and buttock pain. I recommend that you get a thoroughly re-evaluation including physical exam and lab and imaging tests to rule out some of the conditions mentioned above (seronegative spondyloarthritis, Reiter Syndrome).

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