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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!”

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-pathophysiology-2/
  2. https://www.hss.edu/conditions_rheumatoid-arthritis-imaging-overview.asp
  3. https://www.webmd.com/pain-management/radiofrequency-ablation#1
  4. https://opentextbc.ca/anatomyandphysiology/chapter/9-4-synovial-joints/
  5. http://www.rimed.org/medhealthri/2012-04/2012-04-105.pdf
  6. http://www.rimed.org/medhealthri/2012-04/2012-04-105.pdf
  7. http://www.ncbi.nlm.nih.gov/pubmed/8606562?dopt=Abstract
  8. https://radiopaedia.org/articles/sacroiliac-joint

Comments

  • pugpen
    1 year ago

    Thanks for your response Andrew. I do need to go for updated xrays. I have dizziness when I turn my head a certain direction and at times I have fallen flat on my back as a result of this. The crepitus can be heard by anyone standing next to me and as I said before I have the shooting pain down my arms into my hands, I wasn’t sure the dizziness was from my neck previously but it’s exactly the same this time so I feel pretty confident that is where it’s coming from. I don’t have these symptoms constantly by any means, doesn’t seem to be any rhyme or reason to it. If it continues then I’ll definitely make an appt. My lumbar region is where the facet joints come into play. Dx is DDD L3-S1, spondylolisthesis L4-L5, multilevel facet arthropathy L4 to S1 with foraminal central stenosis L3-S1, worse at L4-L5.And something about endplate involvment, not exactly sure, but you get the picture. I have daily pain from this, and most recently have been having pain like between the hip joint area’s, when I sit there is like a ‘curtain’ of pain that radiates from there down both legs to the mid thigh area’s. Sacroilliac area. Anyway, I need to go be evaluated for this also. I have lost 22#, thinking that would help with this back pain, and although it has helped how I feel in general, I can’t say it’s helped my pain. I stretch, eat a healthy diet, and walk and garden for exercise. It seems nothing is helping. I’ve done the PT, epidural injections route also. Anyway, I really just wanted to say that I was happy to find out that RA does affect the facet joints. I plan to ask my rheumy about his take on it, but then when you’re already on one of the strongest biologics and prednisone and NSAID’s and DMARD’s then really what else is left to do? Thanks for listening to me! Cheryl

  • Andrew Lumpe, PhD moderator author
    1 year ago

    Thanks for sharing Cheryl and I do hope that you get things checked out. You never want to mess around with the back and neck. Take care. Andrew

  • pugpen
    1 year ago

    Andrew, I’m thrilled to actually find someone who has almost the exact same problems as myself, RA & neck & lumbar spine problems. I have advanced cervical spinal DDD with stenosis. That was the dx 2 yrs ago via xrays. The surgeon I saw then was amazed that I didn’t have more painful symptoms considering the amount of ‘mechanical damage’ I have. I’ve done fairly well over the past 2 yrs, but as of yesterday my symptoms are back and maybe a little worse than before. My question is—(if you don’t mind me asking)–would you go thru that surgery again? Did it really help your pain and symptoms? I appreciate your time and if you don’t mind chatting, maybe we could compare notes on our lumbar spines also? Thanks, Cheryl PS I was dx with RA 1999

  • Andrew Lumpe, PhD moderator author
    1 year ago

    Hi Cheryl, sorry you’ve been through the ringer with your neck. I encourage you to keep an eye on your neck and have regular images/exams done. Symptoms have to reach a certain threshold for them to recommend surgery. The surgery is a fairly common one now and there are many experienced surgeons out there. And there are various differences in approaches so make sure to carefully choose a surgeon and ask about their approach. It is an in depth process and most doctors require an overnight stay in the hospital. I would do the surgery again because I was having serious symptoms that required quick attention. It has helped symptoms but recovery took a long time. Andrew

  • Dalia
    1 year ago

    Andrew, so sorry to hear of your ongoing spinal troubles. I was having L5-SI issues and had the radiofrequency ablation done. It hurt more than an injection or aspiration, but my pain has been well controlled for 6 years! I still get a flare up now and again, but it’s not chronic like it was. I hope you find relief! Gentle hugs!

  • Andrew Lumpe, PhD moderator author
    1 year ago

    Hi Dalia,
    Good to hear that you’ve been doing well for so long. I’m actually just sitting down on the computer a couple of hours after getting the RFA so we’ll see how it goes!
    Andrew

  • Lawrence 'rick' Phillips moderator
    1 year ago

    Andrew, my spine was my first and most persistent issue. Ouch. Thus the question is it RA or AS? The verdict? Both. You have to love the autoimmune process. We are caldrons of stuff.

  • Andrew Lumpe, PhD moderator author
    1 year ago

    Hey Rick, sorry for your spine issues. My rheumy believes that I have a combination of RA and AS for a variety of reasons. Cauldrons is a great word to use to describe what’s going on inside these crazy, complex bodies.
    Andrew

  • Lawrence 'rick' Phillips moderator
    1 year ago

    Oh I agree Andrew. I call it the witches brew of chronic disease.

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