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Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic type of inflammatory arthritis related to an autoimmune disease.  In the spine, it causes inflammation of multiple spinal joints (facet joints) and affects children and adults.  RA is considered a systemic disease because it can affect other parts of the body (eg, eyes).  Although rheumatoid arthritis is a long-lasting (chronic) disease, symptoms may flare up and then not return for a long time period.  Ankylosing spondylitis is a type of inflammatory spinal arthritis. 

Although the cause of rheumatoid arthritis is not known, it is thought that something in the environment or infection can trigger the body’s immune system to attack itself.  This attack sets off an inflammatory cascade of problems that destroy cartilage and erode bony joints.

Rheumatoid arthritis and the spine
Pain is the foremost symptom.  If the cervical spine is affected, pain may be felt at the base of the skull, neck, upper back, shoulders, or arms.  In the lumbar spine, low back pain may be accompanied by leg pain.  Other symptoms may include:

  • Headache
  • Stiffness
  • Loss of joint motion
  • Loss of muscle strength
  • Fatigue
  • Loss of appetite
  • Fever
  • Difficulty sleeping

Talk with your doctor
If your pain is chronic, severe, or progressive, talk with your doctor.  He will want to know if pain is accompanied by neurological problems such as numbness, tingling sensations, and weakness. 

More serious (rare) symptoms, requiring urgent medical care, include difficulty walking, loss of coordination, and bladder or bowel dysfunction.  These symptoms can be caused by pressure on the spinal cord or cauda equina (low back).

A proper diagnosis is important to treatment.  Your doctor will review your medical history, current symptoms and compare it to information collected during a physical and neurological examination.  Special lab tests may be orders to evaluate your rheumatoid factor and immune system function, determine your liver function, measure your blood count, and other information essential to your health.

Treatment
There are many non-surgical therapies your doctor may recommend to ease the pain and symptoms related to spinal rheumatoid arthritis.

  • Over-the-counter medications: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs)
  • Prescription drugs: oral steroids to reduce inflammation, disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor (TNF) alpha inhibitors to reduce prevent joint damage, immune suppressants, pain relievers, and anti-depressants
  • Physical therapy; stretches to increase flexibility, exercise to build muscle
  • Occupational therapy; performing activities of daily living, coping skills
  • Stress management
  • Alternative therapies such as acupuncture

Most patients with spinal RA do not need surgery.  Surgery may be recommended if pain is uncontrollable, neurologic problems develop (nerve root or spinal cord compression), spinal instability, or weakness is severe.  

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