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Rheumatoid Arthritis and Back Problems

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I’m writing about back problems and Rheumatoid Arthritis since I’ve been asked several times to discuss this topic. This is a blog that is a mixture of experience and questions, not a scientific examination or review of all back issues.

 I’ve met so many Rheumatoid Arthritis patients with back problems

Like many with Rheumatoid Arthritis, back “problems” plague me – some car accidents and injuries add to the RA. For years, I lived with chronic pain not knowing the causes, being laid up for a few days or several weeks, neglecting to seek treatment. If you’re curious about my history of “denial” with medical problems, please see my full e-patient story on e-Patients.net.

Over the past year and a half, I’ve been looking for back pain answers. It has taken awhile to find someone to do tests and look at the MRI of my spine and consider what treatment should be done.

I’m not going to detail my back problems here. I have never discussed them before because I don’t want to take the spotlight off RA and similar serious autoimmune arthritis diseases. But I’ll discuss some parts that I think relate to RA because I’ve heard from so many other Rheumatoid Arthritis patients with back pain. Of course our friends with Ankylosing spondylitis know back pain well.

Some have tried to set me straight about whether Rheumatoid Arthritis can affect the spine. Let me count the ways!

treating a Rheumatoid Arthritis backDegenerative disc disease is a problem is common with RA. It does have an inflammatory and possible auto –immune component. The discs can degenerate in anyone, but with RA patients, it can be accelerated. I wonder if this is related to the accelerated aging that is sometime attributed to Rheumatoid Arthritis. An example of that is the increase osteoporosis and osteoarthritis that RA patients also experience.

However, my doctor is less interested in my damaged discs since he suspects my pain is related to RA in my facet joints, which join the vertebrae. The synovial tissue can become inflamed and the bone itself can be damaged by RA.

The doctor gave me literature describing the function of spine joints and how the treatments are performed. It’s very informative and, when I read it in black and white, I cannot understand why so many people are confused about whether RA affects the spine. There are books and websites from “reputable” sources that say it’s not possible. Odd.

Last month, I had some facet joint injections in 4 lumbar joints. I didn’t notice much difference, but I want to share in case this helps anyone else. This procedure is done with needles. It is outpatient, much like going to the dentist. There is a local anesthetic injection and then a steroid is injected into the facet areas to decrease inflammation. You can get back off the table and walk out in five minutes. The worst part is the anxiety of someone poking you near your spine, but I’ve read that some doctors will give a relaxation medication to make it easier.

The guy who’s working on my back has never looked me in the eye in three visits. I don’t think he’s worried about whether I’m nervous. But so far, I’m ok.

 2-step fix for Rheumatoid Arthritis back pain

The next procedure that we have planned is completely different. There are two different joints that have caused pain for many years which he believes relates to RA. One is cervical and one is thoracic. I have pain running down my arm from one; and the other causes migraines and ear pain.

The first step of the procedure is a medial branch block (here’s a cool video explaining this procedure) to anesthetize the nerve to the facet joint by injection. If this relieves the pain for a few days, it confirms that the culprit (correct facet joint) has been found. Second step: Radiofrequency ablation destroys the nerve endings of that facet joint. The doctor said that if it’s successful, pain relief typically lasts nine months. That is the time it could take for the nerve endings to restore themselves to their former annoying levels.

I can’t imagine life without back or neck pain; I lived with it for so long. But I’ll tell you what I told the doctor: I can’t do it anymore with RA. I can’t compensate using my arms to hold myself up or drag myself around when my back goes out because my hands, elbows, wrists, and shoulders cannot withstand my weight. I am just as nervous about these treatments as others have told me they are, but it’s just like the DMARDs now: I have to fight if I want to have any life at all. That’s just what I’ve decided.

Postblog: An important Rheumatoid Arthritis back problem we can’t leave out

Another important back problem related to RA is instability. RA can cause instability anywhere, but if this occurs in certain joints, it can lead to paralysis or death. I’ve interviewed an RA patient, Nicole Bradshaw, who survived the most devastating result of cervical instability, basilar invagination.  Nicole was lucky; it can be fatal. I’m reviewing a book on this topic called Death by Rheumatoid Arthritis, by Carla Jones. As I’ve stated before, neck involvement occurs in the majority of RA patients – about 87% have cervical spine involvement within two years of diagnosis.

Please note – whenever I talk about the spine, I mention a warning that a prominent chiropractor gave me. She told me never to allow anyone to adjust my spine since it is affected by my RA. The instability mentioned above can prove devastating. Not every RA patient is affected by this warning, but I feel it is critical.

Link to recent post answering “How did it go?”

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Kelly Young. All rights reserved.

This entry was posted on Tuesday, September 28th, 2010 at 6:00 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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