Oh My Aching Back – RA Can Impact Your Spine
In the 11 some years battling rheumatoid arthritis, there have been many encounters fought in joints from throughout my body. This includes joints more commonly associated with RA like fingers, hips, and elbows. But some of my most difficult struggles have been in the spinal region. In 2014 I was sent to the emergency room by my rheumatologist when struggling with neck pain, the ability to hold up my head, and with feeling and movement in my arms and fingers. Shortly after, surgery was conducted to remove the discs and to fuse vertebrae C5-C7. I wrote about this experience in an earlier post.
The destructive biological processes of RA tend to concentrate in synovial joints.
These are joints in which the bones are separated by cartilage and are surrounded by a fluid-filled capsule. It is within this synovial fluid that the immune system initiates a response that causes inflammation and tissue damage. Thus, the swelling, pain, and joint damage common in RA.1
There are several synovial joints in the spinal column that can be impacted by RA. The spinal column is made of vertebrae bones, cartilage discs, a pair of joints on the posterior side of the vertebrae called facet joints and the spinal cord from the brain carrying nerves to the rest of the body. The vertebrae are numbered for reference purposes (e.g. C1 = first cervical or neck vertebra, L1 = first lumbar or lower back vertebra). The joints between the vertebrae are not synovial joints. However, the facet joints are synovial joints and they can be subjected to the destructive processes of RA.2
Facet joints and the impact on them caused by RA
My recent battle has been with facet joints in two regions of the spine – C2-C4 and L3-L5. Six months ago, I bent over to put away a cleaning solution under the sink. Upon rising, a sharp pain went shooting through my lower back putting me in bed for several days. The usual rest, muscle relaxants, and stretching did not help. After six weeks, my primary care doctor ordered an MRI which showed several issues including bulging discs, bone spurs, and facet joint arthritis. She referred me to a pain management physician. At the first consult, this doctor conducted a thorough exam and reviewed my history including that of my neck. It didn’t take him long to focus on the facet joints. He stated that sensory nerves come out of the spine near the facet joints and they can get pinched causing pain in the region. He even suspected that ongoing headaches(an earlier post) may be caused by nerve pinching in the neck. In addition to getting physical therapy and starting in the nerve pain medication Lyrica, he started the process of “burning” the nerve roots via a process called radiofrequency ablation (RFA).3 This procedure, which he does under brief general anesthesia, involves the placement of small probes near the nerve roots. Radiofrequency pulses are then used to heat the probe to 80 degrees Celsius which cauterizes the nerve causing an interruption in pain signals. These sensory nerves are not involved in bodily function or body movement. The nerves can grow back over time resulting in the return of pain. Patients may receive anywhere between 3-24 months of relief and the procedure can be repeated if needed. Time will tell if this procedure will provide relief to both the lower back and neck. Surgery to fuse the vertebra can be used to keep the facet joints from moving.
A second type of synovial joint in the spinal column is the atlantoaxial joint which is found between the C1 and C2 vertebrae in the upper neck region.4 One of the more serious neck conditions related to RA is atlantoaxial subluxation which involves a stair stepping of the vertebrae. This condition occurs in up to 30% of RA patients.5 When this situation occurs at the C1-C2 levels right next to the skull, it can put dangerous compression on the brain stem resulting in permanent nervous system damage and even death. Up to 12% of RA patients show this symptom.6 Given the seriousness of this condition, some researchers recommend surgical intervention at an earlier stage before irreversible damage occurs.6 If you have RA and have any concerns about your neck, please bring them up with your doctor.
A third type of synovial joint associated with the lower vertebrae is the sacroiliac (SI) joint.7 I’ll be writing a separate article about this joint in the future since I’m also dealing with this “pain in the butt!”
Quiz: Which is NOT a common risk factor for osteoporosis?