From the Guidelines
Moderate degenerative changes of the sacroiliac (SI) joint should be managed with a multimodal treatment approach, starting with conservative management including physical therapy and over-the-counter pain medications, as recommended by the most recent guidelines 1.
Initial Management
- Conservative management is the first line of treatment, including physical therapy focusing on core strengthening and SI joint stabilization exercises.
- Over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours as needed, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-800mg three times daily with food) can be used for 1-2 weeks.
- Applying heat or ice to the affected area for 15-20 minutes several times daily can help alleviate pain and inflammation.
- Wearing an SI belt during activities can provide joint stability and support.
Further Treatment Options
- If pain persists, consulting with a healthcare provider about corticosteroid injections into the SI joint can provide 3-6 months of relief.
- For severe cases unresponsive to conservative treatment, minimally invasive procedures like radiofrequency ablation or, rarely, SI joint fusion surgery might be considered.
- Maintaining a healthy weight and avoiding high-impact activities can help prevent further degeneration of the SI joint.
Diagnostic Considerations
- The diagnosis of axial spondyloarthritis (axSpA) is based on a combination of physical examination, biologic data, and imaging findings, as outlined in the Assessment of SpondyloArthritis International Society (ASAS) classification system 1.
- Conventional radiography of the SI joints and symptomatic regions of the spine is the primary method of following structural progression of disease, with a general recommendation of no more frequently than every 2 years 1.
- MRI may be helpful for evaluation of inflammatory lesions and disease progression.
From the Research
Moderate Degenerative Changes of SI Joint
- The sacroiliac joint (SIJ) is a common source of lower back pain, with estimates suggesting it contributes to pain in up to 38% of cases 2.
- Moderate degenerative changes of the SI joint can lead to pain and functional impairment, and may require surgical stabilization and/or fusion if conservative management fails 3.
- Diagnostic criteria for SI joint dysfunction include pain in the area of the SI joint, reproducible pain with provocative maneuvers, and pain relief with a local anesthetic injection into the SIJ 2, 4.
- Treatment options for SI joint dysfunction include conservative measures such as medications, physical therapy, and intra-articular injections, as well as interventional and surgical options like radiofrequency denervation and SI joint fusion 2, 5, 4.
- Minimally invasive SI joint fusion has been shown to be effective in reducing pain and improving physical function and quality of life in patients with chronic SI joint pain who have not responded to conservative treatment 6.
- The effectiveness and safety of minimally invasive SI joint fusion have been demonstrated in several studies, with improvements in pain and physical function reported at 6 months and 1-2 year follow-up 6.
Treatment Options
- Conservative treatment consists of a multimodal program combining patient education, pelvic girdle stabilization with focused stretching, and manipulative therapy 4.
- Interventional treatment options include intra-articular corticosteroid injections, cooled radiofrequency ablation, and SI joint fusion 4.
- Surgical management involves open and percutaneous approaches, with minimally invasive options available for improving pain and function and maintaining a low adverse event profile 2, 5.