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Treatments and drugs
By Mayo Clinic staffThe type of treatment your doctor will recommend depends on the signs and symptoms you're having, as well as the underlying cause of your sacroiliitis.
Medications
- Pain relievers. If over-the-counter pain medications don't provide enough relief, your doctor may prescribe a non-narcotic pain reliever, such as tramadol (Ultram). Occasionally, a short course of narcotics may be prescribed. These drugs are habit-forming and shouldn't be used for long periods of time.
- Muscle relaxants. Medications such as cyclobenzaprine (Flexeril) may help reduce the muscle spasms often associated with sacroiliitis.
- Corticosteroids. Drugs such as betamethasone (Celestone) or triamcinolone (Kenalog) can be injected into the joint to reduce inflammation and pain. But you can receive only a few joint injections a year because the steroids can weaken your joint's bones and tendons.
- Disease-modifying antirheumatic drugs (DMARDs). If your sacroiliitis is caused by ankylosing spondylitis, you may be helped by drugs such as sulfasalazine (Azulfidine) and methotrexate.
- TNF inhibitors. Tumor necrosis factor (TNF) inhibitors — such as etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) — often help relieve the type of sacroiliitis that's associated with ankylosing spondylitis.
Therapy
Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to maintain joint flexibility, and strengthening exercises to give your muscles additional stability.
Surgical and other procedures
If other methods haven't relieved your pain, you doctor might suggest:
- Radiofrequency denervation. Radiofrequency energy can damage or destroy the nerve tissue causing your pain.
- Electrical stimulation. Implanting an electrical stimulator into the sacrum may help reduce pain caused by sacroiliitis.
- Joint fusion. Although surgery is rarely used to treat sacroiliitis, fusing the two bones together with metal hardware can sometimes relieve sacroiliitis pain.
- Isaac Z, et al. Sacroiliac joint dysfunction. In: Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/199872655-3/994114554/1678/50.html#4-u1.0-B978-1-4160-4007-1..50049-3_767. Accessed May 6, 2010.
- Williams KD, et al. Injection studies. In: Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/199872655-4/0/1584/296.html?tocnode=55688040&fromURL=296.html#4-u1.0-B978-0-323-03329-9..50042-8--cesec38_1984. Accessed May 6, 2010.
- van der Linden, et al. Ankylosing spondylitis: Pathology. In: Firestein GS, et al. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: W.B. Saunders Co.; 2008. http://www.mdconsult.com/das/book/body/199988049-3/994442372/1807/513.html#4-u1.0-B978-1-4160-3285-4..10070-1--s0200_2539. Accessed May 7, 2010.
- Anderson BC. Evaluation of the adult with hip pain. http://www.uptodate.com. Accessed May 7, 2010.
- Inman RD. The spondyloarthropathies. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/199988049-4/994442372/1492/1025.html#4-u1.0-B978-1-4160-2805-5..50291-3--cesec7_12895. Accessed May 7, 2010.
- Chang-Miller A (expert opinion). Mayo Clinic, Scottsdale/Phoenix, Ariz. May 17, 2010.
- Cohen SP, et al. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008;109:279.
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