Rheumatoid Arthiritis In The Spine
Causes Pain in the Back, Neck, Arm and Legs
Arthritis affects approximately 80% of people over the age of 55 in the United States. There are many different types of arthritis, however they are all are associated with inflammation, joint pain, loss of movement and progressive degeneration of the joint surfaces. (The word arthritis literally means "joint inflammation" (arth = joint, ritis = inflammation).
Osteoarthritis is chronic breakdown of cartilage in the joints, the most common form of arthritis occurring usually after middle age.
Rheumatoid arthritis is a chronic and progressive disease in which the immune system attacks the joints. It is characterized by pain, inflammation and swelling of the joints, stiffness, weakness, loss of mobility and deformity.
Arthritis can affect any joint in the body, including the joints in the spine. Generally speaking, spinal arthritis occurs in the facet joints (also called vertebral joints) that connect vertebrae.
Facet joints facilitate movement in the spine such as for bending, twisting, and stretching, but these joints can thicken and harden with age and reduce flexibility. In addition, cartilage breakdown can cause bone-on-bone friction and the resultant pain can be mild to severe. Facet joints can then become inflamed, and progressive joint degeneration that is part of the normal aging process creates even more frictional pain.
In addition, as arthritis develops in the spine and cartilage wears away, the ends of facet joints are exposed and begin to rub directly against one another causing the formation of small, irregular bone growths, called bone spurs or osteophytes. Arm and leg pain may be caused by these bone spurs exerting pressure on adjacent nerves. This condition is also known as Spinal Stenosis, Foraminal Stenosis, and Lateral Recess Stenosis.
Back and neck pain can be due to degeneration of the joints, causing pain in the joints themselves.
Causes of Arthritis in the Spine
Arthritis is generally considered to be a process which comes with aging. The same applies to Spinal Stenosis which is seen more commonly as a person gets older. It may be seen in younger individuals when that person has suffered trauma to the spine, or when they have had repeated injuries to the spine, as is the case in certain athletes.
Determining the cause of arthritis can be difficult because several factors often contribute to an individual developing this common problem.
Much of the diagnosis comes with the history and exam of the patient, followed by detailed imaging of the spine. X-rays are a good screening study which will show bone spurs.
MRI scans are extremely helpful. CT scans of the spine and myelograms followed by a CT scan may be very helpful in certain cases. When there is question as to which level of the spine is causing the problem, EMG / nerve conduction studies may help. In certain situations, selective epidural steroid nerve root blocks may be useful as well.
Risk Factors / Prevention
Unfortunately, there is no way to prevent the aging process. Therefore, arthritis will generally affect most people as they age. The aging process is accelerated by improper lifting, smoking, as well as excessive body weight.
There are ways to slow this process down. By staying in good shape, exercising, and keeping weight down, stress on the joints is reduced, causing less repetitive trauma to the joints, and decreasing the progression of arthritis.
Nonsurgical Procedures: Physical Medicine / Physical Therapy
- Traction may reduce stress on the joints, help to open the disc spaces, and reduce pain.
- Hot packs will help to warm the muscle, increase blood flow to the muscle, and reduce pain in muscles affected by strain.
- Ultrasounds will help to deliver heat to the deep muscles, where the hot packs cannot reach.
- Electrical stimulation will stimulate the muscles to reduce pain in them.
- Massages will manipulate the muscles, stretch them, and increase blood flow while reducing pain.
- Stretching exercises will help to relieve tension by stretching the muscles and tendons, which connect muscles to bones.
- Medications such as anti-inflammatory medications may help to reduce inflammation and reduce the pain of arthritis. Narcotics, while not generally advised for arthritic pain, may be of benefit for situations in which severe nerve compression causes significant pain.
- Epidural steroid injections given to the epidural space which surround the nerves, help to decrease swelling and inflammation in the nerves.
- Facet joint block and injections, the combination of steroid medicine and anesthetic medicine, may help to relieve pain.
- Laminotomy / laminectomy: Removal of bone spurs which surround the nerve roots can relieve pain. This may involve a more limited surgery to free up one or two nerve roots or it may involve a more extensive surgery in which a multilevel decompressive laminectomy with the possibility of a fusion may be needed. If there is no lower extremity pain, but purely back pain, then a fusion of the spine may potentially be of benefit.
The prognosis is quite good. There is generally little danger associated with arthritis although the pain can be annoying and disruptive to one's life.
With surgery, there is often a good chance of relieving arm or leg pain when the pain is caused by a bone spur compressing a nerve.
On the other hand, joint pain in the spine may be a little more difficult to fix on a long-term basis. With advances in fusion techniques, outcomes are continuing to improve.
In situations where arthritic spurs compress the spinal cord in the neck, surgery may be necessary to prevent future spinal cord injury.
For more information on Arthritis in the Spine or for a consultation at the Kraus Back and Neck Institute please call: