The major clinical presentation in OCI is low back pain of mechanical character that is aggravated by activity and relieved upon resting. The patients often describe the non-radicular back pain as radiating down to the posterior thighs.
Usually, the iliac bone near the sacroiliac joint is affected in a bilateral and symmetric process. OCI is predominant in women of child-bearing age. However, rare incidents of men and nulliparous women with OCI is possible. OCI may be unilateral .
The sacrum may also be involved since the changes are not always limited to the iliac bones. The joint spaces are generally normal. However, an occasional lipping, and narrowing of the lower margin or minimal irregularities may be observed. Cases have long remissions and even though the onset can be associated with pregnancy, subsequent pregnancies do not necessarily worsen the symptoms. There are no collateral and consistent systemic disturbances or physical and radiological findings .
The pregnancy-associated ligamentous laxity of the sacroiliac joint (SIJ) can result in persistent instability and sclerosis of the joint in some cases. This can later present as SIJ tenderness. The course of the disease is chronic and it may relapse.Therefore, OCI should be differentiated from other inflammatory or non-inflammatory disorders of the sacroiliac joint  .
The diagnostic criteria of OCI includes  :
In addition, a thorough history and physical examination can help differentiate OCI from ankylosing spondylitis, sacroiliitis, seronegative spondyloarthropathies, primary hyperparathyroidism, renal osteodystrophy, Paget's disease, bone secondaries and lymphoma     . Normal blood tests and seronegativity can exclude most of these conditions.
The radiographical appearance of OCI is described as a well defined triangular sclerosis of the iliac bone in the sacroiliac joint. Eburnation can be observed in the inferior part of the bone. Sclerosis can extend to the auricular portion of the iliac bone. Unlike other forms of sacroiliitis, the joint space is not obliterated in OCI and the articular margins remain intact. The radiological features of OCI can resolve over time .
In a small group of patients affected with OCI, polyarthralgia in the peripheral joints has been reported. However, significant inflammatory articular changes are usually absent.