Rheumatoid Arthritis and Low Back Pain
Many people with rheumatoid arthritis (RA) also experience back pain, particularly around the low back. It hurts when you lie down; it hurts when you sit; it hurts when you even think about moving. Is it connected to your RA and what can you do to cope?
RA and your spine
Although RA doesn’t affect the vertebrae in your spine, there are some joints in this area that can be affected. One is the atlantoaxial joint at the top of your spine, and there is some debate about whether RA can affect your sacroiliac joint in your pelvic region, although most rheumatologists will disagree with this. However, between each vertebra there is a small facet joint which serves as a stabilizer. And because it is a joint, it can be affected by RA. In severe cases, this can cause damage that allows the vertebrae to move and put pressure on the spinal cord or nerve roots.
Symptoms of facet-joint pain may include tenderness over the involved vertebra, more pain when leaning back then leaning forward, as well as pain that radiates down through the buttocks and the back of the upper leg.
Other causes of back pain
There are multiple other causes of back pain that are not related to RA. Conditions such as osteoporosis, fibromyalgia, spinal stenosis, degenerative disc disease, and osteoarthritis in the spine may all cause back pain. Degenerative disc disease may even be connected to autoimmune disease. A study found that the cause of degenerative disc disease may involve an immune cell that causes inflammation in autoimmune conditions (interleukin-17). More research is needed to further assess this possible connection.
As well, some people have more than one autoimmune condition, which may include other forms of inflammatory arthritis that affects the spine. The most common of these is ankylosing spondylitis.
Diagnosing low back pain
When your doctor works to diagnose a problem with your back, the first factor to consider is whether it is acute or chronic. Acute back pain may have been caused from a strain in your back through twisting, using inappropriate technique when lifting something heavy, as well as other causes. Chronic back pain is usually caused by a problem in your spine or another area of your body. One study found that 64.5 percent of people with RA also have low back pain, and that they reported more problems with function, depression, and low quality of life.
To diagnose the cause of your back pain, your doctor will perform a physical examination, as well as ask questions about when and how your back hurts. They will likely send you for an X-ray or a magnetic resonance image (MRI) to check whether the pain is caused by a structural problem in your spine. You may also receive a referral for a specialist, such as an orthopedic surgeon or neurologist for a more specialized assessment and diagnosis. If facet joint involvement is suspected, the specialist may do a procedure called a medial branch nerve block. If this relieves the pain, it confirms that the facet joint is involved.
Treating low back pain
The treatment of low back pain depends very much on the cause. Commonly, they are quite similar to how you treat RA pain. Hot and cold packs applied to the tender area, medication, such as non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, and potentially gentle stretches. Although you may be tempted to stay horizontal, it’s recommended that bed rest be kept at a minimum. Going through your day as normally as possible may actually help you heal faster.
If your pain is due to RA inflammation in the facet joints, a steroid shot may help reduce the pain. Another procedure used to treat facet joint pain is called medial branch radiofrequency neurotomy or ablation, which places a heat lesion on the nerve to interrupt the pain messages. This procedure has a success rate of about 30-50 percent significant relief for as long as two years.
What you can do to prevent and treat low back pain
There are numerous things you can do to reduce low back pain. Keeping your spine in alignment by getting good posture as you walk, sit and lie down is essential. Daily stretches and exercises can also help keep your back from seizing up, as well as strengthening the muscles surrounding your spine. Your doctor will be able to give you a referral to physical therapy where you can learn the right exercises for your body, as well as get tips for maintaining the posture.
Being overweight can increase the pain in your leg joints when you have RA and it can also put a strain on the spine. If this is a factor in your back pain, you may want to talk to your doctor about a referral to a dietitian for help in losing weight.
Whether caused by RA or other factors, low back pain can have a significant effect on your ability to smile and get through the day. Talk to your doctor about your pain and don’t forget to pay attention to ways that you can help yourself get better.
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