From the Guidelines
Sacroiliitis in young males is most commonly caused by spondyloarthropathies, particularly ankylosing spondylitis, as supported by the most recent evidence from 2021 1.
Causes of Sacroiliitis
The causes of sacroiliitis in young males can be multifactorial, including:
- Spondyloarthropathies, such as ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease-associated arthritis
- Infectious sacroiliitis from bacteria like Staphylococcus aureus
- Trauma, especially in athletes ### Pathophysiology The pathophysiology of sacroiliitis typically involves genetic factors, particularly HLA-B27 positivity, which is present in 74% to 89% of patients with axial spondyloarthritis 1. This genetic predisposition combined with environmental triggers leads to inappropriate immune activation and inflammation at the sacroiliac joints.
Diagnosis
Diagnosis typically requires imaging (X-rays, MRI) and laboratory tests including HLA-B27, inflammatory markers (ESR, CRP), and sometimes synovial fluid analysis to rule out infection. MRI of the sacroiliac joints is widely recognized as an important tool in the evaluation of patients with suspected axSpA, resulting in improved diagnostic confidence and yielding findings that stimulate changes in both diagnosis and treatment plans for patients 2.
Treatment
Treatment depends on the underlying cause but often includes NSAIDs like naproxen 500mg twice daily or indomethacin 25mg three times daily for inflammation, physical therapy to maintain mobility, and in more severe cases, disease-modifying antirheumatic drugs or biologics such as TNF inhibitors (etanercept 50mg weekly or adalimumab 40mg every other week) 1.
From the Research
Causes of Sacroillitis in Young Males
- Sacroillitis, inflammation of the sacroiliac joint (SIJ), may be associated with many rheumatic and nonrheumatic disorders 3
- The condition can result from various factors, including inflammatory low back pain, and may be difficult to diagnose due to its diverse presentations and limitations of imaging modalities 3, 4
- Bacterial septic sacroiliitis is an uncommon diagnosis that can occur in young adults, often making it difficult to diagnose due to nonspecific physical examination findings 5
Diagnosis and Treatment
- Diagnosis of sacroiliitis typically begins with the presentation of lower back pain and confirmatory diagnostic testing through fluoroscopy joint block 4
- Treatment options include conservative approaches such as physical therapy and analgesics, as well as interventional methods like corticosteroid injections, prolotherapy, radiofrequency ablation, and SI joint fusion surgery 4, 6
- Magnetic resonance imaging (MRI) can be used to identify sacroiliitis earlier than plain radiography, with a positive predictive value of 60% for the development of sacroiliitis on plain radiography after 3 years 7
Specific Considerations for Young Males
- HLA-B27 positive patients with inflammatory low back pain are at risk of developing sacroiliitis, and MRI can be used to detect early sacroiliitis in these patients 7
- A thorough history and physical examination, along with diagnostic tests such as a diagnostic block, are essential to properly identify the source of pain and develop an effective treatment plan 4, 6