Can Rheumatoid Arthritis cause back problems?

Rheumatoid Arthritis is a systemic disease, which can affect all joints in the body. The facet joints at the level of the lumbar spine are similar to other joints in the body. They contain cartilage, ligaments and synovium and can be modified by Rheumatoid Arthritis. When arthritis affects a person's joints in the hands, the disease may be very obvious. Rheumatoid arthritis can lead to swollen joints and deformation with a loss of function. Arthritis of the lumbar spine may be less obvious to the sight but can lead to severe symptoms of pain, nerve irritation and weakness. There may be nothing obvious at first glance in your lumbar and lumbosacral spine. However, investigation must be carried out with regard to stenosis, facet joint subluxation, spine instability using X-rays with stress, flexion and extension views and perhaps a CT scan or MRI.

Treatment of Rheumatoid Arthritis often involves the intake of Prednisone or other steroid medications, which may have side effects on bone such as osteoporosis. Some compression fractures may occur in the spine. In patients under treatment for Rheumatoid Arthritis is is thus important to obtain a detailed evaluation including X-rays and possibly an MRI.

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What is a Sciatica?

The word "sciatica" is applied to define a pain which follows the sciatic nerve. The sciatic nerve is made of nerve roots coming out of the spine between the lowest lumbar vertebrae and the upper sacral vertebrae. Converging and merging together in the pelvis they become a big nerve trunk (the sciatic nerve) which goes from the pelvis to the leg distributing nerve supply to numerous structures (muscles, joints, skin …) of the leg.

Any irritation or compression of one or more nerve roots of this sciatic nerve as well as of the nerve trunk may cause a pain following the nerve distribution and is called a "sciatica". Disc diseases (herniated disc, extruded disc) are often associated with a sciatica. These symptoms may develop suddenly (acute), such as due to a herniated disc. The condition may also be chronic which is frequently the result of problems such as disc degeneration, ruptured discs, instability or stenosis. Other less frequent problems may cause direct or indirect compression of the sciatic nerve at the level of the roots or along its path.

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What is the cause of low back pain in most people?

In the majority of cases the exact cause of low back pain is not identified. If an underlying source of pain is not identified then a diagnosis of idiopathic back pain or myofascial back pain is often given. It is important to seek consultation by a specialist for back pain since there are some treatable and specific disorders that can lead to severe or persistent pains. These include: infection (discitis, osteomyelitis), degenerative disc disease, ruptured disc, herniated disc, tumor, fracture, and others. In the normal aging process the spine develops degenerative changes which can lead to mechanical pain (brought on by activity or changes in position), frequently this responds to exercise therapy (stabilization program).

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How common is low back pain?

Low back pain is one of the most common painful conditions. It has been estimated that up to 80% of all people have back pain which is disabling at some time in their lives. Most back pain occurs without any particular cause which a patient remembers. Similar to its onset, back pain usually disappears even if no particular treatment is given. Back pain usually only lasts for up to several weeks. It is much less common to have pain which lasts for more than 6 to 12 weeks. Severe or persistent pain should be evaluated by a spine specialist. Back pain which goes into the legs and involves any urinary or bowel habit changes should be closely evaluated.

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Can low back pain be serious?

Although most cases of back pain are not very serious and clear up on their own, there are some medical conditions which can lead to back pain and require proper diagnosis and treatment. Some of the signs that something more serious may be going on include: pain at night, fevers, sweats, weight loss, a previous diagnosis of cancer, weakness in the legs, difficulty controlling urination, burning with urination, numbness about the genitalia, abdominal pains. If there is any suspicion of a more serious medical condition causing back pain, then it is essential to have a complete evaluation by an experienced medical doctor.

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What is the best treatment for my low back pain?

A variety of treatments are offered to treat low back pain. These include: heat treatments, massage, TENS (electrical stimulation), ultrasound, chiropractic manipulation, physical therapy, exercise programs and medication. None of these treatments have been clearly proven to be any better than a gradual return to regular daily activities. Medication is often taken to alleviate the pain. What is important to remember though is that comfort and reduced pain during the recovery from low back pain, may be obtained for a particular patient with one or more of the modalities listed above. Although those treatments have not been clearly proven to be effective they may give you some relief. The best recommendation is to rest briefly (up to 2-3 days) if the pain is severe, but then begin to get into your usual activities gradually after that. Once you are recovering from low back pain, getting into a regular exercise program for overall conditioning and strengthening of back muscles has been shown to reduce the chance of further back problems.

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