Rheumatoid Arthritis and the Spine

Unlike osteoarthritis, which is a degenerative disease, rheumatoid arthritis (RA) is an autoimmune disease. Although rheumatoid arthritis research is ongoing, scientists generally believe that RA occurs when white blood cells mistakenly attack the synovial membrane that lines the joints, causing inflammation.

According to the University of Washington Orthopaedics and Sports Medicine, approximately 20 to 30 percent of cases of rheumatoid arthritis affect the joints of the spine.

In cases of rheumatoid arthritis and the spine, the most commonly affected area is the cervical spine, particularly the upper neck at vertebrae C1 and C2. However, rheumatoid arthritis does sometimes affect the lower neck and the upper and lower back. RA destroys joints, which can lead to rheumatoid arthritis symptoms such as instability, pain, architectural changes, and in advanced cases, compression of the spinal cord and nerves.

Rheumatoid Arthritis Symptoms

Common rheumatoid arthritis symptoms include:

• Difficulty sleeping
• Fatigue
• Fever
• Loss of appetite
• Morning stiffness lasting more than 30 to 60 minutes
• Paresthesias (abnormal sensations, such as burning or prickling)
• Weakness
• Widespread muscle aches.

Rheumatoid arthritis progresses to pain and swelling in the affected joints. If RA is affecting your neck, you may also experience headaches, neck pain and weakness in the arms.

Treatment of Rheumatoid Arthritis Symptoms

Although rheumatoid arthritis has no cure, medications can relieve symptoms and slow down the progress of the disease. Non-steroidal anti-inflammatory drugs (NSAIDs) are often a first choice of doctors, but other rheumatoid arthritis treatments include:

• Antidepressants
• Corticosteroids
• COX-2 inhibitors
• Disease-modifying anti-rheumatic drugs (DMARDs)
• Immunosuppressants.

For those who are suffering from these arthritis symptoms, physical therapy may help improve, maintain or restore muscle. Exercises may work to improve:

• Coordination
• Flexibility
• Mobility
• Strength.

Other modalities, such as massage and hot and cold treatments, may help relieve painful rheumatoid arthritis symptoms.

If other rheumatoid arthritis treatments don't work, surgery may be an option if you have:

• Myelopathy (compression of the spinal cord) from cervical spine instability
• Severe weakness that causes functional disability
• Uncontrollable pain combined with neurological dysfunction.

The goal of RA surgery is to remove the tissue pressing on the spinal cord or nerves and to make the spine more stable. Some other potential benefits of surgery include:

• Decompressing compromised nerves decreases pain, stops progressive loss of nerve function and sometimes improves function
• Fusing the affected vertebrae (spinal fusion) eliminates rheumatoid arthritis symptoms in the area
• Restoring the normal alignment of the spine prevents deterioration of basic vital functions
• Stabilizing the spine can protect the spinal cord from potentially paralyzing injury.

Resources

Chapman, J. (2009). Spine surgery for rheumatoid arthritis. Retrieved March 17, 2010, from http://www.orthop.washington.edu/uw/spinesurgery /tabID__3371/ItemID__66/Articles/Default.aspx

Spinasanta, S. (n.d.). What is rheumatoid arthritis? Retrieved March 17, 2010, from http://www.spineuniverse.com/conditions/spinal-arthritis/rheumatoid-arthritis/what-rheumatoid-arthritis

Spinasanta, S. (n.d.). Anatomy of rheumatoid arthritis. Retrieved March 17, 2010, from http://www.spineuniverse.com/conditions/spinal-arthritis/rheumatoid-arthritis/anatomy-rheumatoid-arthritis

Spinasanta, S. (n.d.). Symptoms of rheumatoid arthritis. Retrieved March 17, 2010, from http://www.spineuniverse.com/conditions/spinal-arthritis/rheumatoid-arthritis/symptoms-rheumatoid-arthritis

UCLA Comprehensive Spine Center Staff. (n.d.). Conditions and disorders: Rheumatoid arthritis. Retrieved March 17, 2010, from http://spinecenter.ucla.edu/body.cfm?xyzpdqabc=0