The 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 used for sacroiliitis treatment may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs). These pain-relieving drugs reduce swelling and inflammation. NSAIDs include indomethacin (Indocin) and naproxen (Aleve, Anaprox, others). Your doctor may prescribe these medications on an as-needed basis or continuously, depending on the severity of your condition.
Taking NSAIDs can lead to side effects, such as indigestion and stomach bleeding. Other potential side effects may include damage to your liver and kidneys, and high blood pressure. Except for aspirin, NSAIDs may also increase your risk of cardiovascular events, such as heart attack or stroke. The risk of side effects from these medications is higher in people who already have pre-existing medical conditions, such as liver or heart disease.
Corticosteroids. These medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain and slow joint damage. Cortisone injections can be used for localized pain relief that lasts a period of months.
In the short term, corticosteroids can make you feel dramatically better. But when used for long periods of time, they may cause serious side effects. Side effects may include an increased risk of infection, easy bruising, thinning of bones, cataracts, weight gain and a round face. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
For people with sacroiliitis associated with ankylosing spondylitis, there is no definitive evidence that oral steroids will help, and people with ankylosing spondylitis are more prone to developing osteoporosis.
Disease-modifying antirheumatic drugs (DMARDs). These medications include sulfasalazine (Azulfidine) and methotrexate (Rheumatrex). Doctors prescribe DMARDs to limit joint damage. Taking these drugs at early stages in the development of a joint condition is especially important to slow the disease and save the joints and other tissues from permanent damage.
Because many of these drugs act slowly, DMARDs typically are used with an NSAID or a corticosteroid. While the NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD modifies the disease itself. Sulfasalazine may be helpful in treating arthritis of the leg and arm joints, but it's currently not considered effective for people with the spinal symptoms associated with ankylosing spondylitis. Studies done on another drug, methotrexate, have had conflicting results. More studies are needed to determine whether methotrexate will be useful in treating sacroiliitis related to ankylosing spondylitis.
- Tumor necrosis factor (TNF) inhibitors. These therapies, which include etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade), block a cell protein (cytokine) that acts as an inflammatory agent. Blocking the TNF cytokine may help reduce pain, stiffness, and tender or swollen joints. Because of their high cost, these medications are generally considered only after you've tried other treatments for at least three months without success.