Back pain in rheumatoid arthritis: what causes it and how to treat it

While rheumatoid arthritis (RA) most often affects peripheral joints, such as those in the hands, feet, and knees, some people with RA also report experiencing back pain.

However, keep in mind that if the main symptom is low back pain, it is probably not due to RA. Several types of inflammatory arthritis affect the spine, especially spondyloarthropathies such as psoriatic arthritis and ankylosing spondylitis, in which back pain is one of the main symptoms of the disease. (Read more about the symptoms of ankylosing spondylitis here and about the symptoms of psoriatic arthritis here).

To help demystify back pain among people with rheumatoid arthritis, we ask Marcy Bolster, MD, associate professor of medicine at Harvard Medical School and director of the Scholarship Rheumatology Training Program at Massachusetts General Hospital , answer the questions that many RA patients have when they meet. Deal with back pain.

How does rheumatoid arthritis cause back pain?

In terms of spinal involvement, RA primarily affects the cervical spine, which is located in the upper part of the spinal cord and forms the neck. While it is possible that the middle or lower back is affected, this is considered rare.

“If a patient with established RA arrives with pain in the middle or lower back, he is less likely to think that his symptoms are directly related to RA,” says Dr. Bolster.

This is why the cervical spine is most frequently affected: in RA, the immune system attacks the synovial membrane, the thin membrane that lines the joints; It is the main site of the inflammatory process in rheumatoid arthritis.

The two upper vertebrae of the spine, C1 and C2, are synovial-lined joints and, therefore, are subject to the development of inflammation and joint erosion that you experience in your peripheral joints.

It is not clear how many people with RA have cervical spine involvement. It usually develops in the later stages of RA, but Dr. Bolster says it was previously reported.

“My back pain started fairly quickly, within the first year of my diagnosis of RA,” says CreakyJoints community member Lisa Powell, who experiences both cervical and lumbar back pain. “My doctor has not completely ruled out that osteoarthritis may be the cause of damage to the lower part of my back, but the pain seems to be closely related to the symptoms of RA.” It gets worse when my RA is burning or not well controlled. ”

What are the long-term consequences of back pain related to RA?

Middle or lower back pain is usually a mechanical problem and does not occur due to RA. However, in some cases the disease can indirectly cause pain in the middle or lower back. For example, severe pain in other joints could alter the mechanics of your gait, which could cause back pain over time.

“My neck was the most affected by my RA, but my lower back also hurts, and I think that is due to the pain in my hips and knees,” says Mary Eldreth Pearson, a member of CreakyJoints. “If I have to stand for more than 30 minutes, my lower back hurts more.”

RA can also indirectly affect the back because it increases a person’s risk of developing osteoporosis, says Dr. Bolster. Although osteoporosis itself is not painful, it can cause fractures due to insufficiency of the vertebral bodies in the thoracic and lumbar spine.

“If someone with RA presented with sudden back pain, that could indicate a compression fracture of the spine, which occurs in people with osteoporosis,” he explains.

If RA does not cause middle or lower back pain, what else could be the fault?

Your rheumatologist will likely consider potential causes, including:

  • Osteoarthritis
  • Degenerative disc disease
  • Herniated disc
  • Pinched nerve
  • Spinal stenosis
  • Conditions not related to the spine that can cause back pain (kidney stones or infections, for example)

How is back pain related to RA treated?

If you have C1 or C2 participation, your rheumatologist can work in collaboration with a neurosurgeon to treat and control it, since surgery is sometimes necessary. However, surgery is reserved for more advanced cases in which spinal instability has begun to exert pressure on the spinal cord and many people never reach this stage. Therefore, your pain is more likely to be managed with non-invasive treatments.

To treat inflammation and slow joint erosion in the cervical spine, Dr. Bolster says that aggressive treatment of the underlying arthritis with disease-modifying anti-rheumatic drugs (DMARDs) is important.

DMARDs can help relieve back pain by treating the underlying inflammation that can affect the cervical spine. NSAIDs, paracetamol and / or muscle relaxants are used to treat both the pain associated with the involvement of the cervical spine by RA and the pain of the middle and lower back that people with RA may have, but that is not occurs due to RA Your rheumatologist may also recommend other ways to keep back pain at bay.

“Physiotherapy and exercise are important parts of the treatment of back pain,” says Dr. Bolster. A physiotherapist can teach you stretching and strengthening exercises, especially core strengthening exercises, which you can do at home and your rheumatologist will probably recommend that you perform low-impact exercises, such as cycling and swimming. If you are overweight, weight loss can benefit the symptoms of your back pain.

CreakyJoints member Dave Stinson says that while exercise has not resolved his back pain, it has helped.

“I ride my bike, walk and add stretching protocols to my routine, and I have high hopes of attending a yoga class in the near future,” he says. Renewing your diet and losing weight have also made a difference in the management of back pain with rheumatoid arthritis. When his back bothers him, he treats it with ice, heat and NSAIDs.

Powell also credits weight loss and exercise to relieve back pain from rheumatoid arthritis.

“I recently learned about an exercise technique called Egoscue, and my overall level of pain has really improved since I started doing it,” he says. (The Egoscue Method focuses on postural problems that can cause pain). “Between that, my weight loss and finally finding a medication that controls my symptoms quite well, I’m closer than ever to remission in the eight years I’ve had RA.”

Your rheumatologist may also recommend assistive devices to alter the mechanics of your posture and gait to help control your back pain. Pearson uses a cane or sometimes a walker if necessary. Powell, a full-time student, says her doctor advised her to use ergonomic furniture to support her when she has to sit for long periods.

“I enrolled in my university’s disability services and they provided me with an adjustable height table and an ergonomic chair for all my classes,” he says. “It has been a great help”.

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