30-Year-Old With Back Pain

Differential Diagnosis

• Sacroiliac joint osteoarthritis
• Sacroiliitis
• Osteitis condensans ilii
• Ankylosing spondylitis

Diagnosis

The correct diagnosis in this case is osteitis condensans ilii. This x-ray shows triangular sclerosis of the bilateral iliac sides of sacroiliac joints. Minimal sclerosis of the right sacrum adjacent to the joint is observed.  With osteitis condensans ilii, the sacroiliac joint is normal with no irregularity, erosions, or loss of joint space.

What to Look For

• Characterized by benign sclerosis of the ilium adjacent to the sacroiliac joint, it is typically bilateral and triangular in shape.
• The condition is usually asymptomatic but may cause axial lower back pain, buttocks or thigh pain—typically not centered over the sacroiliac joints.
• While osteitis condensans ilii has a low incidence, it is more common in women than men. In women, it is seen primarily in pregnancy and the puerperium period after giving birth.

Pearls for Urgent Care Management

• Osteitis condensans ilii is benign and self-limited.
• Initial treatment is with anti-inflammatory medications, physical therapy, and rest.

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